Hepatitis is inflammation in the liver, which is a major cause of infection-related deaths worldwide. People are many times more likely to catch viral hepatitis than diseases like HIV, so hepatitis is indeed a public health concern.

While viral infection is one of the most common causes of hepatitis, liver inflammation can also be caused by toxic substances (alcohol, drugs, etc.) or illnesses such as fatty liver or autoimmune disease. Hepatitis can lead to fibrosis (liver scarring), cirrhosis (late-stage badly scarred liver), and even liver cancer. Of the five main types of viral hepatitis (A, B, C, D, and E), three are preventable by vaccines given to children or adults. Vaccinations are available at doctors’ offices and public health clinics for all ages, and at many local pharmacies such as CVS or Walgreens for teens and adults.

Hepatitis A and E usually cause acute, temporary infections. Hepatitis B, C, and D not only cause acute infections but also often become chronic and long-lasting, which leads to cirrhosis and liver cancer. Doctors can order simple blood tests to see if a person is immune to hepatitis A or B, with immunity being from vaccinations or prior infection. Doctors can also order blood tests to see if a person is a chronic carrier of hepatitis B, C, or D.

Different people can experience viral hepatitis in different ways, especially over time. Some people feel sickly with fever, nausea, vomiting, yellow skin (jaundice), and dark urine, while others don’t have any outward signs or symptoms. Doctors can interview patients via video or in person to help decide if the patients (or their family members and close contacts) should do blood tests to check for infection or immunity.

Quest Diagnostics lab tests commonly used by doctors include:

• 508 HepA Ab total, for immunity

• 8475 HepB surface Ab quantitative, for immunity

• 498 HepB surface Ag with reflex confirmation

• 501 HepB core Ab total

• 8472 HepC Ab with reflex to quantitative RNA PCR

• 10306 Acute Hepatitis Panel with reflex confirmation (HepA-IgM, HepBs-Ag, HepBc-IgM. HepC-Ab)

Quest Diagnostics lab tests occasionally used include:

• 8369 HepB virus quantitative DNA PCR

• 4990 HepD Ab total

• 36582 HepE Ab IgM

• 36583 HepE Ab IgG

Hepatitis A vaccination

Hepatitis A vaccination began in the 1990s and has been recommended for all U.S. children since 2006. Current shots begin at age 12 months and are usually a two-shot series for children or adults. Commonly used brands for all ages are Havrix and VAQTA. Twinrix is a combined Hepatitis A & B vaccine for adults only.

Hepatitis A can be transmitted through contaminated food and water and is in an infected person’s poop (stool). Sexual activity where traces of stool from an infected person gets into another person’s mouth can spread hepatitis A. Patients usually recover within a couple of months and don’t carry the virus afterwards. About 80 people in the U.S. die from hepatitis A each year. 

Hepatitis A is the most common vaccine-preventable disease acquired during traveling. Travelers should plan ahead and ask their doctors about vaccines 2–3 months before foreign travel.

Hepatitis B vaccination

Hepatitis B vaccination began in the 1980s and has been recommended for all U.S. children since 1991. Current shots begin at birth and are usually a three-shot series for children or adults. Commonly used brands for all ages are Engerix-B and Recombivax HB. Two newer vaccines with special attributes are PREHEVBRIO and HEPLISAV-B, both for adults only.

Hepatitis B virus is spread when blood or body fluids from an infected person enter the body of a person who is not immune, such as through having sex with an infected person, sharing needles while using recreational drugs, exposure to needlesticks on the job, or from mother to baby during birth. Breastfeeding is safe for newborns vaccinated with the current U.S. protocol. The body fluids which may transmit hepatitis B include semen, vaginal secretions, and sometimes saliva. Exposure to infected blood in any situation is a risk for infection to an unvaccinated person, which is why being vaccinated beforehand is the best protection. About 2,000 people in the U.S. die from hepatitis B each year.

Hepatitis C vaccination

There is no vaccine available yet, but research is ongoing.

Hepatitis C virus is found in blood and body fluids. The virus is spread when blood or body fluids from an infected person enter another person’s body. Hepatitis C is spread through sharing needles while using recreational drugs, exposure to needlesticks on the job, or sometimes from a mother to her baby during birth. It is possible to transmit hepatitis C during sex, but such transmission is less common.

Hepatitis D vaccination

Hepatitis B vaccine prevents hepatitis D in persons not already infected with hepatitis B virus.

Hepatitis D virus (HDV) is an unusual virus in that it needs the presence of hepatitis B virus (HBV) to build the outer envelope of the hepatitis D virus. Hepatitis D infection can cause acute or chronic hepatitis, but cannot occur without the presence of hepatitis B virus.

For hepatitis B virus carriers (people with chronic hepatitis B), every effort should be made to reduce the chances of their catching hepatitis D. For people who haven’t caught hepatitis B, prevention of hepatitis D infection is done by vaccinating against hepatitis B virus.

Hepatitis D infection is uncommon in Western countries and is mainly seen in high-risk groups such as injection drug users, individuals who have received multiple transfusions in the past, or persons who moved from areas with a high prevalence of hepatitis D such as the Mediterranean Basin, Central Asia, and Mongolia.

Hepatitis E vaccination

No vaccine is available in the U.S., but there is a hepatitis E vaccine available only in China. A gamma globulin shot (IgG injection) is not effective prevention.

Hepatitis E is transmitted through contaminated food and water, and is in an infected person’s poop (stool). Sexual activity where tiny bits of stool from an infected person gets into another person’s mouth can spread the virus. Hepatitis E and A have very similar modes of transmission. People usually recover fully from hepatitis E and do not carry the virus afterwards, except maybe in immunosuppressed organ transplant patients.

Summary

Viral hepatitis is common in the U.S. and across the world, causing acute illnesses sometimes and chronic liver disease other times.

• Hepatitis A, B, and D are prevented by vaccines available to children and adults.

• Hepatitis C has no vaccine, and the vaccine for hepatitis E is only available in China.

• Hepatitis B or C patients sometimes have no symptoms for years but later develop liver scarring (fibrosis, cirrhosis) or liver cancer.

• Some persons are at much higher risk of catching hepatitis, depending on their lifestyle activities, their sexual contacts, the part of the world they come from, and exposure to infected friends or relatives.

• A doctor online or in person is the most reliable source for advice and evaluation to see if a person should be checked for viral hepatitis infection, or be tested for immunity to hepatitis A and B.

• Hepatitis tests ordered by the doctor can be done at nearby labs such as Quest Diagnostics or LabCorp.

• Vaccinations can be ordered by an online doctor and obtained at many local pharmacies.

You can talk to a doctor about hepatitis symptoms and prevention. Visit HealthTap to book a virtual visit with your personal care doctor.