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Overview of Hepatitis

By Anna E. Rutherford, MD, MPH, Assistant Professor of Medicine;Clinical Director of Hepatology, Harvard Medical School;Brigham and Women’s Hospital

Hepatitis is inflammation of the liver.

Hepatitis is common throughout the world.

Hepatitis can be

  • Acute (short-lived)

  • Chronic (lasting at least 6 months)

Most cases of acute hepatitis caused by a virus (acute viral hepatitis) resolve on their own, but some progress to chronic hepatitis.

Did You Know...

  • Vaccines can prevent some types of viral hepatitis or decrease its severity.

  • A few simple, common-sense precautions can also help prevent hepatitis.

Causes

Hepatitis commonly results from

  • A virus, particularly one of the five hepatitis viruses—A, B, C, D, or E

  • Use of certain drugs, such as isoniazid (used to treat tuberculosis)

  • A reaction of the immune system that causes inflammation of the liver (autoimmune hepatitis)

Less commonly, hepatitis results from other viral infections, such as infectious mononucleosis, herpes simplex, or cytomegalovirus infection.

The Hepatitis Viruses

Transmission

Symptoms and Prognosis

Prevention

Ingestion of something contaminated with the stool of an infected person), usually because of poor hygiene or inadequate sanitation (called the fecal-oral route).

Usually no symptoms in young children

Usually in older children and adults, typical symptoms of acute hepatitis (poor appetite, nausea, vomiting, and often jaundice)

Usually complete recovery

Does not become chronic

Use of good hygiene when handling food and avoidance of contaminated water

Vaccination against hepatitis A for all children (see Figure: Vaccinating Infants and Children) and for adults likely to be exposed to the infection

If people are exposed to hepatitis A, hepatitis A vaccine or standard immune globulin*

Less easily transmitted than hepatitis A

Contact with blood and other body fluids (such as semen, vaginal fluids, or saliva)—as occurs during the following:

  • Sharing of unsterilized needles to inject illicit drugs

  • Reuse of unsterilized needles to apply tattoos

  • Sexual activity

  • Birth of a baby

Generally more serious than hepatitis A and occasionally fatal

More severe symptoms when people with hepatitis B also have hepatitis D

Joint pains and itchy red hives on the skin (wheals) in addition to typical symptoms of acute hepatitis

Can become chronic, with increased risk of liver cancer

Avoidance of high-risk behavior, such as sharing needles to inject drugs and having several sex partners

Vaccination against hepatitis B for all children (starting at birth—see Figure: Vaccinating Infants and Children) and for people likely to be exposed to the infection

If people are exposed to hepatitis B (including babies born to mothers with hepatitis B), hepatitis B immune globulin* and the vaccine

Contact with blood and other body fluids (such as semen, vaginal fluids, or saliva)—as occurs during the following:

  • Sharing of unsterilized needles to inject illicit drugs

  • Reuse of unsterilized needles to apply tattoos

  • Sexual activity (not commonly)

  • Birth of a baby (not commonly)

At first, usually mild or no symptoms but sometimes alternating between mild and more severe symptoms

Becomes chronic in about 75% of people, with increased risk of severe scarring of the liver (cirrhosis) and liver cancer, but usually only if cirrhosis has developed first

Avoidance of high-risk behavior, such as sharing needles to inject drugs and getting tattoos and body piercings,

No vaccine currently available

Contact with blood and other body fluids (such as semen, vaginal fluids, or saliva)—as occurs during the following:

  • Sharing of unsterilized needles to inject illicit drugs

  • Reuse of unsterilized needles to apply tattoos

  • Sexual activity

Occurs only as a coinfection with hepatitis B and usually makes the hepatitis B infection more severe

Same as for hepatitis B:

  • Avoidance of high-risk behavior

  • Vaccination against hepatitis B

  • If people are exposed to the hepatitis B virus, the vaccine plus hepatitis B immune globulin*

Ingestion of something contaminated with the stool of an infected person, usually because of poor hygiene or inadequate sanitation (called the fecal-oral route)

Occasionally consumption of meat from an infected animal

Severe symptoms, especially in pregnant women

Does not usually become chronic

Vaccination against hepatitis E (currently, available only in China)

*Standard immune globulin is a preparation containing antibodies obtained from the blood (plasma) of people with a normal immune system. It is used to treat a variety of diseases. Hepatitis B immune globulin contains antibodies obtained from the blood of people who have high levels of antibodies to hepatitis. It is given by injection into a muscle or into a vein.

A pregnant woman infected with hepatitis B or hepatitis C can transmit the virus to her baby.

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