What is hepatitis? How to prevent infection

You’ve been feeling extra tired and achy lately. You’ve lost your appetite—and you’re experiencing nausea and vomiting, maybe with a fever. These could be signs of the seasonal flu, or another more serious illness (like COVID-19). But, if you’ve also noticed yellowing of your eyes or skin, it could be hepatitis.

It’s a common condition. As of 2017, 3.3 million people were living with viral hepatitis alone, according to the Centers for Disease Control and Prevention (CDC). And it can be serious without appropriate treatment. Learn the risk factors for hepatitis, how to prevent it, and what to do if you’re infected.

What is hepatitis?

Hepatitis means inflammation of the liver. A virus is the most common cause of this condition—but can also be triggered by drug or alcohol abuse, an autoimmune reaction, or chronic disease.

When left untreated, acute hepatitis can lead to cirrhosis, chronic liver disease, liver failure, liver cancer, or even require a liver transplant.

Types of hepatitis

When people think of hepatitis, they often think of viral infections that target the liver, says Robert Fontana, MD, medical director of liver transplantation at the University of Michigan. There are five types of viral hepatitis.

Hepatitis A is caused by the hepatitis A virus (HAV) and usually clears on its own after a few weeks. Symptoms are similar to that of the flu, though some people present as asymptomatic.
Hepatitis B is caused by the hepatitis B virus (HBV) and usually clears on its own after a few months. However, an infection that persists after six months is considered chronic hepatitis B. Symptoms include jaundice (yellowing of the skin and eyes), nausea, vomiting, and diarrhea, though some people present as asymptomatic.
Hepatitis C is caused by the hepatitis C virus (HCV) and only clears on its own in about 20% of cases. Symptoms include jaundice, fatigue, and joint pain, but acute hepatitis C can lead to cirrhosis or liver disease even without symptoms.
Hepatitis D is caused by the hepatitis D (HDV) virus and can be chronic. Symptoms include jaundice, abdominal pain, and nausea, though some people present as asymptomatic. Hepatitis D only occurs in those who have hepatitis B, making it a rare form of hepatitis.
Hepatitis E is caused by the hepatitis E (HEV) virus and often clears on its own after a few weeks. Symptoms include jaundice, loss of appetite, dark urine, and abdominal pain. Hepatitis E is often spread through contaminated drinking water, making it rare in developed countries.

However, there are other ways the liver can become inflamed—like blood flow problems, gallstones, and excessive alcohol consumption.

Alcoholic hepatitis is caused by heavy alcohol consumption and requires abstinence and/or medical intervention to clear. Symptoms include jaundice and fluid retention, but many people present as asymptomatic.
Autoimmune hepatitis is caused when the immune system attacks the liver. This form is chronic. Symptoms include fatigue and joint and abdominal pain.
Nonalcoholic fatty liver disease doesn’t have a known cause. However, obesity, high cholesterol, and Type 2 diabetes are risk factors. Symptoms are rare, but may include fatigue.

Within the United States, cases of hepatitis A, B, C, and alcoholic hepatitis, are the most common types. The World Health Organization (WHO) estimates that 325 million people worldwide have hepatitis B and/or C.

Transmission

The way hepatitis spreads varies by the types of hepatitis.

Viral hepatitis transmission

Hepatitis A and E are often transmitted orally when a patient ingests the virus via food or drink—usually contaminated by feces from an infected person.

Hepatitis B, C, and D are most often transmitted when bodily fluids are exchanged between an infected person and another person. That can occur in several ways: birth to a mother with the virus, sex with an infected person, sharing personal hygiene (i.e., razors) or medical equipment, such as glucose monitors. Hepatitis B is most commonly transmitted through sexual contact or by an infected mother passing it to her child during pregnancy. It can also spread through shared syringes with illicit drug use.

“What we’re seeing is that if you use drugs, you have a significant likelihood of acquiring hepatitis C from someone else because people share needles,” says Dr. Fontana. He says there are about 1 million people per year who are experimenting with illicit drugs, resulting in a recent recommendation from the U.S. Preventive Services Task Force (USPTF) that all adults are tested at least once for hepatitis.

Other hepatitis transmission

Other forms of hepatitis do not spread person to person. They are caused by medical conditions or alcohol consumption. Alcohol is one of the more common liver toxins, and hepatitis from excessive alcohol intake is a real concern among medical professionals. “Alcoholic liver injury is on the rise significantly in all age groups, but particularly amongst younger people,” Dr. Fontana explains. “Younger people tend to think they’re invincible, but we’ve seen people here in the hospital who are 25-30 years old whose livers are dying.”

Furthering this concern, alcohol consumption during the COVID-19 crisis has significantly increased while people are home and out of work, adds Dr. Fontana. People often think that because they’re home, feeling okay, and not yellowing, they don’t need to be worried, but severe inflammation can occur without any symptoms of hepatitis. “As a doctor, I’m very concerned about that,” Dr. Fontana says. “You can be developing liver injuries from alcohol, and if you wait until you get jaundiced, that’s a very, very severe form.”

Hepatitis treatment and medications

“All forms of hepatitis are potentially treatable, but some forms aren’t always curable,” says Anthony Michaels, MD, hepatologist and associate professor of Clinical Medicine at The Ohio State University Wexner Medical Center.

Hepatitis viruses can be treated with antiviral medications if they don’t clear on their own. If a toxin is causing the inflammation, it needs to be removed from the liver. If it’s due to a gallstone or other blockage outside the liver, a doctor needs to mechanically relieve it.

Hepatitis A often clears on its own with adequate rest.
Hepatitis B may clear on its own, but a chronic infection requires antiviral medication such as entecavir, adefovir dipivoxil, tenofovir disoproxil fumarate, or lamivudine.
Hepatitis C is the best example of a viral hepatitis that can be treated and cured, as chronic hepatitis C treatment often includes antiviral and other medications, including Epclusa, Promacta, Pegasys, or Intron A.
Hepatitis D doesn’t have a known treatment, but avoiding alcohol can help prevent the condition from worsening.
Hepatitis E often clears on its own with adequate rest and fluids.
Alcoholic hepatitis liver damage can potentially be reversed by adhering to abstinence from alcohol. In other cases, corticosteroids or pentoxifylline ER may be required.
Autoimmune hepatitis can be treated with drugs that control the immune system, including prednisone or Imuran.
Nonalcoholic fatty liver disease can potentially be reversed through diet, exercise, and weight loss.

Common side effects of antiviral drugs include nervousness, inability to concentrate, and stomach upset.

Because hepatitis is a general term, it’s important to seek medical attention to determine the best way to treat your specific condition.

Prevention

Hepatitis A infection and hepatitis B infection can both be prevented by vaccine. Many children in the U.S. receive the hepatitis A and B immunizations before going to school, but that wasn’t always the standard. If you don’t remember whether you’ve been vaccinated, the hepatitis B vaccine was recommended to school-aged children beginning in 1994 and the hepatitis A vaccine in 2006. If you haven’t been vaccinated for these types, ask your doctor for a catch-up vaccine. While there’s a vaccine in development for hepatitis C, there isn’t one available yet, so it’s important to avoid behaviors that can increase the risk of hepatitis C.

Beyond vaccinations, making your physician aware of family histories of liver diseases as well as monitoring certain behavioral factors are the best way to prevent hepatitis.

Hepatitis A and E: Wash your hands after using the restroom and before eating. Drink only bottled or purified water in developing countries.
Hepatitis B and C: Wear a condom with sex partners and avoid contact with body fluids and blood. Pregnant women have a high risk of passing the virus infection to their child. Don’t share needles or personal care items (including razors and toothbrushes) and only get tattoos or piercings from clean, reputable businesses.
Hepatitis D: The best way to avoid hepatitis D is to prevent and/or treat hepatitis B.
Alcoholic hepatitis: Avoid alcohol misuse, abuse, and binge drinking.
Autoimmune hepatitis: There is no way to prevent autoimmune hepatitis, but routine health examinations can help diagnose this type of hepatitis early.
Nonalcoholic fatty liver disease: Monitor your diet, get regular exercise, and maintain a healthy weight.

The way a doctor detects hepatitis is through blood tests and through a physical exam. If you have a risk factor, such as use of intravenous drugs, unprotected sex, or heavy alcohol use, ask your healthcare provider to test you for hepatitis C. People don’t want to tell their doctors how much they’re drinking or that they’re doing drugs, but you can still ask to be screened for hepatitis.

Finally, “you can have a liver condition and not know it,” Dr. Fontana says. “With heart disease, everyone knows about chest pain and cholesterol. Liver disease is a little more of a mystery to most people. As a liver specialist, if people would just ask a question when they see their doctor, there are a lot of treatable things we can do.”