Viral Hepatitis

Viral Hepatitis (a kind of hepatitis caused by a virus) can cause liver inflammation and damage. There are five main types: hepatitis A, B, C, D, and E.

Overview

Hepatitis means inflammation, or swelling, of the liver. Viruses are a common cause, but hepatitis can develop from heavy alcohol use, toxins, certain medicines, and autoimmune disease. For this page, we refer to viral hepatitis unless otherwise noted.

There are five known types of viral hepatitis: A, B, C, D, and E. Each type spreads differently and affects the body in different ways.

Some types of viral hepatitis cause only a short, or “acute,” infection that goes away on its own. Other types can become long-lasting, or “chronic”. Hepatitis A and E typically cause only acute infections. Hepatitis B, C, and D can cause both acute and chronic infections.

Chronic hepatitis is serious. It can lead to cirrhosis, or scarring of the liver, liver failure, and liver cancer. Early diagnosis and treatment can help prevent these problems.

Types of Viral Hepatitis

Hepatitis A

Hepatitis A spreads through contact with the stool of someone who has hepatitis A. This could occur by eating contaminated produce, food prepared by someone who did not wash their hands, or by drinking untreated water. Hepatitis A has increased in unhoused populations and people who use drugs. A person with hepatitis A, is most contagious during the 2 weeks before the symptoms appear and may be contagious for up to 3 weeks after symptoms develop. Children are often contagious longer than adults. Symptoms appear 2-7 weeks after contact with the virus.

There are no specific medicines to treat hepatitis A. Doctors recommend rest, plenty of fluids, and healthy foods. They also recommend avoiding alcohol and medicines that can damage the liver. Most people recover on their own within 6 months.

Hepatitis B

Hepatitis B spreads through contact with blood, semen, or other body fluids—through sex without a condom, sharing needles, or from mother to child during birth. Learn more on the Sexually Transmitted Infections topic page.

People more likely to get hepatitis B include those who:

  • Were born to a mother with hepatitis B
  • Have HIV
  • Have had multiple sex partners or a history of sexually transmitted infections
  • Share pipes and drug inhalation devices or inject drugs Work in a job with contact with blood, needles, or body fluids
  • Live or work in a jail or prison

Symptoms appear 2-5 months after contact with the virus.

Doctors usually do not treat acute hepatitis B unless it becomes chronic. If blood tests show liver damage, doctors may prescribe antiviral medicines. These medicines can lower the chances of liver damage and other problems. If hepatitis B leads to liver failure or liver cancer, a liver transplant may be needed.

Hepatitis C

Hepatitis C spreads mainly through contact with blood, most often by sharing needles or other drug injection equipment. In the United States, injecting drugs is the most common way people get hepatitis C.

People more likely to get hepatitis C include those who:

  • Share pipes and drug inhalation devices or inject drugs or have injected drugs in the past
  • Have HIV
  • Have been on kidney dialysis
  • Received donated blood, blood products, or an organ before 1992
  • Were born to a mother with hepatitis C

Symptoms appear 2-12 weeks after contact with the virus.

Doctors treat hepatitis C with antiviral medicines that attack the virus. Antiviral medicines can cure more than 95% of people with chronic hepatitis C in 8-12 weeks. Some people may need to take antiviral medicines for longer.

Hepatitis D

Hepatitis D spreads through contact with blood or body fluids. Only people who already have hepatitis B will get hepatitis D. Up to 90% of adults with hepatitis D superinfection, meaning they already had hepatitis B and then got hepatitis D, will develop both chronic hepatitis B and chronic hepatitis D.

No medicines have been approved to treat hepatitis D in the United States. In some cases, doctors may recommend medicines called interferons. People with hepatitis D also have hepatitis B and may need treatment for hepatitis B.

Hepatitis E

Hepatitis E spreads mainly through drinking contaminated water. In the United States, it can also spread through eating raw or undercooked pork or deer meat.

Symptoms appear 15-60 days after contact with the virus.

There are no specific medicines that treat most cases of hepatitis E. Doctors recommend rest, plenty of fluids, and healthy foods. In some cases, doctors prescribe medicines to treat chronic hepatitis E. Avoid alcohol until your doctor says you have fully recovered.

Pregnant women who have hepatitis E during the second or third trimester can have higher rates of death (10-30%) or miscarriage. Their babies face increased risk of poor health and birth defects. Hepatitis E also can cause serious illness in people who already have chronic liver disease.

Signs and Symptoms

Many people with hepatitis have no symptoms at all, especially in the early stages. When symptoms do appear, they are often similar across all five types of hepatitis.

Common symptoms of acute hepatitis A, B, C, D, and E may include:

  • Darker urine color and lighter stool color
  • Fatigue, or feeling tired
  • Fever
  • Joint pain
  • Loss of appetite, nausea, or vomiting
  • Pain in the abdomen
  • Yellowish eyes and skin, called jaundice
  • Diarrhea (hepatitis A and E)

Many children younger than age 6 with hepatitis A have no symptoms. Infants and children younger than age 5 with hepatitis B also typically have no symptoms. Most people with chronic hepatitis C have few or no symptoms until complications develop, which can take decades.

Related Health Effects

Untreated hepatitis, especially chronic infections, can lead to serious health problems.

Cirrhosis

Scar tissue replaces healthy liver tissue, preventing the liver from working normally. As cirrhosis gets worse, the liver begins to fail. Learn more about cirrhosis on the Cirrhosis topic page.

Liver failure

Also called end-stage liver disease, liver failure means the liver is badly damaged and stops working properly. People with liver failure may need a liver transplant.

Liver cancer

People with cirrhosis have a higher chance of developing liver cancer.

Hepatitis D and B together

People who have both hepatitis D and B are more likely to develop complications than people with hepatitis B alone. The risk of developing cirrhosis and/or liver cancer in people with both infections is higher than that of people with hepatitis B alone.

HIV coinfection

People with HIV have higher rates of hepatitis B and C than the general United States population. In people with both HIV and hepatitis C, HIV may cause chronic hepatitis C to advance faster. Chronic hepatitis B also advances more rapidly to cirrhosis and liver cancer in people who have both HIV and hepatitis B. Learn more about HIV on the HIV topic page.

Causes and Risk Factors

Drug and alcohol use raises a person’s odds of getting viral hepatitis. People who inject drugs are more likely to get hepatitis B and C from shared needles and other drug equipment. Drug use can directly damage the liver, increasing the risk of chronic liver disease and cancer.

You cannot get hepatitis B or C from:

  • Being coughed or sneezed on
  • Hugging, shaking hands, or sitting next to someone who has hepatitis B or C
  • Sharing food, drinks, or eating utensils

Prevention Guidance

Vaccines are available for hepatitis A and B. Getting vaccinated is the best way to prevent these infections.

The Hepatitis A vaccine is:

  • Given in two shots; the second shot is given at least 6 months after the first
  • Recommended for all children between ages 12-23 months
  • Recommended for older children who have not yet received the vaccine
  • Recommended for adults who are more likely to get hepatitis A, have chronic liver disease or HIV, or are traveling to a country where hepatitis A is more common

Hepatitis B vaccine is:

  • Usually given in three shots over 6 months; some adults may get it in two shots
  • Recommended for everyone ages 59 and younger who has not already been vaccinated, including infants and children
  • Recommended for adults older than age 60 who are more likely to get hepatitis B, have chronic liver disease, or want to be vaccinated
  • Estimated to reduce the risk of hepatitis B by 80-100%

If you think you were exposed to hepatitis A or B, see your doctor right away. A dose of the hepatitis A vaccine or a medicine called immune globulin may protect you from hepatitis A if taken soon after contact. For hepatitis B, a dose of the vaccine, and in some cases a medicine called hepatitis B immune globulin, should be given preferably within 24 hours.

No vaccine is available for hepatitis C or hepatitis D in the United States. The hepatitis B vaccine can prevent hepatitis D since someone must already have hepatitis B to get hepatitis D. A hepatitis E vaccine has been developed and is used in China, but it is not available in the United States.

Other Steps to Prevent Hepatitis Infections

  • Wash hands thoroughly with soap and water for at least 20 seconds after using the toilet and before preparing food.
  • Do not share needles or other drug injections, inhalation, or other smoking equipment.
  • Use a latex or polyurethane condom during sex .
  • Do not share personal items such as toothbrushes, razors, or nail clippers.
  • Make sure tattoo and piercing tools are sterile.
  • Make sure that equipment used in nail salons is sterile and disposable.
  • When traveling to areas where hepatitis A or E is common, drink bottled water and make sure meat is thoroughly cooked.

Diagnosis

Doctors use medical history, physical exams, and blood tests to diagnose hepatitis. Many people do not know they have hepatitis until the disease begins to damage the liver. Screening is important to detect hepatitis early before it causes liver damage.

Blood tests are the main tool to diagnose all five types of hepatitis. Blood tests show:

  • Whether you have been exposed to a hepatitis virus
  • Whether you still have the virus
  • The amount of virus that is in your blood
  • Whether the infection is acute or chronic
  • Whether you are immune to the virus

Screening means testing for a disease even when you have no symptoms. Doctors recommend hepatitis B and C screening for:

  • All adults at least once in their life
  • Pregnant women during each pregnancy
  • Infants born to someone with hepatitis B
  • People with higher chances of getting hepatitis
  • Anyone who wants to be screened

The Centers for Disease Control and Prevention, or CDC, recommends that people who inject drugs are tested for hepatitis B and C as part of routine medical care.

Additional tests for people with chronic hepatitis may include:

  • A special test known as elastography that measures liver stiffness, which may signal scarring
  • Ultrasound or other imaging tests to check for cirrhosis and liver cancer
  • Liver biopsy a doctor uses a needle to take a small piece of liver tissue; doctors typically use this only when other tests do not provide enough information

Physical exam. For hepatitis B, C, and D, doctors check for signs of liver damage, such as changes in skin or eye color, swelling in the lower legs, feet, or ankles, and tenderness or swelling in the abdomen, during a physical exam.

Treatment and Management

Treatment depends on the type of hepatitis and whether the infection is acute or chronic.

For all types of hepatitis:

  • Check with your doctor before taking any prescription or over-the-counter medicines.
  • Talk with your doctor before using dietary supplements, vitamins, or complementary or alternative medicines as some of these can damage the liver.
  • Avoid alcohol until your doctor says you have fully recovered.

Coinfection with HIV

People who have both HIV and either hepatitis B or hepatitis C should be treated for both infections. Some HIV medicines are also effective at treating hepatitis. Learn more on the HIV topic page.

Substance use disorder treatment is important for people who inject drugs, as it can help people reduce or stop behaviors that increase the chance of transmitting hepatitis. Research shows that people with hepatitis who receive medicines for opioid use disorder can be safely treated with antiviral medicines. Learn more on the substance use disorders page.

Living With Hepatitis

If you have hepatitis, there are steps you can take to protect your liver and prevent spreading the infection to others.

Protect your liver:

  • Choose healthy foods and drinks.
  • Avoid alcohol as it can cause more liver damage.
  • Talk with your doctor about healthy eating and maintaining a healthy weight.
  • Check with your doctor before taking any medicines, vitamins, or supplements.

Prevent spreading hepatitis to others:

  • Wash your hands with soap and water after using the toilet.
  • Do not prepare or serve food to others while you are sick (hepatitis A).
  • Tell your doctor, dentist, and other healthcare professionals that you have hepatitis.
  • Do not donate blood, blood products, semen, organs, or tissue.
  • Tell your sex partners about your infection and talk with your doctor about safe sex practices.
  • Your sex partners should get tested and get vaccinated for hepatitis B if they do not have hepatitis B.
  • Do not share drug injections, inhalation, or other smoking equipment.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on hepatitis.

Community Support

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research on all five types of hepatitis. NIH is conducting research to find new treatments that work alone or in combination with current drugs to reduce or resolve chronic hepatitis. NIH also supports research for vaccines to prevent hepatitis A and hepatitis C.

NIH supports the Hepatitis B Research Network, a network of 28 sites in the United States and Canada researching how hepatitis B and D affect children and adults. NIH and other agencies also provide funding for the Liver Cirrhosis Network, which conducts research to better understand factors that increase the risk of developing cirrhosis and new treatments for people with cirrhosis.

NIH-funded research is studying new rapid hepatitis C antibody tests that can be used in drug treatment settings. NIH researchers are also examining coordinated care models that integrate hepatitis C specialty care with primary care, substance use disorder treatment, and mental health services.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.