What is Hepatitis?
Understanding what “hepatitis” means, and how viral forms differ from non-viral.
Hepatitis is inflammation of the liver, caused by various agents, with viral infections being the most common. The five primary viral types are A, B, C, D, and E. This condition can be acute (resolves within 6 months) or chronic (persists beyond 6 months) Non-viral causes include excessive alcohol, certain medications, toxins, and autoimmune disorders.
If inflammation progresses, it can lead to fibrosis, cirrhosis, and eventually liver cancer.
What types of hepatitis are there, and how do they differ?
| Type |
Transmission |
Infection Course |
Severity |
|---|
| A |
Fecal–oral (contaminated food/water) |
Acute only; usually self-resolves |
Mild; rarely dangerous, except pregnancy |
| B |
Blood/body fluids (sex, needles, birth) |
Can be acute or chronic; children often chronic (~90%) |
High risk: cirrhosis & liver cancer |
| C |
Blood-borne (needles, transfusion) |
Often chronic (~75–85%) |
High: fibrosis, cirrhosis, cancer; treatable with modern antivirals |
| D |
Only with HBV; via blood, sex |
Chronic & severe; coinfection worsens prognosis |
Most severe when combined with HBV |
| E |
Fecal–oral (similar to A); zoonotic via raw meat |
Mostly acute, some chronic in immunocompromised |
Mild generally, but can cause liver failure in pregnant women |
Acute vs. Chronic Hepatitis – What’s the Difference?
Understand the crucial distinctions between acute and chronic forms to guide diagnosis and treatment.
Definition and Duration
- Acute Hepatitis:
- Sudden liver inflammation lasting less than 6 months
- Often resolves on its own with supportive care (rest, hydration, avoiding toxins)
- Chronic Hepatitis:
- Inflammation lasting more than 6 months
- Common with Hepatitis B, C, and D virus
- May progress to fibrosis, cirrhosis, or liver cancer if untreated
Symptoms and Long‑Term Outcomes
| Type |
Main Symptoms |
Duration |
Long‑Term Risk |
|---|
| Acute |
Fatigue, nausea, jaundice (sometimes) |
< 6 months |
Usually resolves without long-term damage |
| Chronic |
Persistent fatigue, often asymptomatic |
> 6 months |
High risk of fibrosis, cirrhosis, liver cancer |
Why It Matters
- Diagnosis & Monitoring: Chronic hepatitis may be silent—regular blood tests and ultrasounds are essential.
- Treatment Decisions:
- Acute may require only home care
- Chronic often needs antiviral therapy, liver fibrosis assessment, lifestyle changes
- Preventing Complications: Timely management reduces risks of advanced liver disease
How is Each Type of Hepatitis Transmitted?
Hepatitis A (HAV)
- Main route: Fecal–oral transmission from contaminated food or water, or poor hand hygiene after using the toilet (hopkinsmedicine.org)
- Less common: Sexual practices involving oral–anal contact (especially among MSM)
- Prevention tip: Always wash hands before eating and avoid undercooked or unclean food.
Hepatitis B (HBV)
- Main route: Blood and body fluids—unprotected sex, sharing needles, mother-to-child during childbirth
- Other sources: Shared personal items (razors, toothbrushes), medical tools with infected blood
- Prevention tip: Practice safe sex, avoid sharing personal items, and get vaccinated.
Hepatitis C (HCV)
- Main route: Blood-to-blood contact, such as shared needles or poorly sterilized tattoo/piercing tools
- Occasional: Sexual transmission—risk increases if there’s blood exposure or in high-risk groups
- Prevention tip: Never share needles or sharp tools; use only sterile equipment.
Hepatitis D (HDV)
- Dependency: Can only infect individuals already infected with hepatitis B
- Transmission: Bloodborne and sexual routes, like HBV
- Prevention tip: Prevent HBV to prevent HDV.
Hepatitis E (HEV)
- Main route: Fecal–oral from contaminated water or undercooked meats (especially pork, deer)
- Rare: Blood transmission in immunocompromised or vertical (mother-to-child) transmission
- Prevention tip: Cook meat thoroughly and drink clean water.
Summary Table
| Virus Type |
Main Transmission |
Less Common |
Prevention |
|---|
| A |
Contaminated food/water |
Oral–anal sex |
Handwashing, clean food |
| B |
Blood, sex, childbirth |
Shared items |
Vaccination, safe sex |
| C |
Blood (needles, tools) |
Sexual (rare) |
Avoid sharing needles/tools |
| D |
Only with HBV (same routes) |
— |
Prevent HBV infection |
| E |
Contaminated food/meat |
Blood (rare cases) |
Cook meat, use clean water |
Which Hepatitis Type Is the Most Dangerous?
Compare hepatitis A–E by chronic risk, cancer potential, and special vulnerability
| Type |
Chronic Risk |
Liver Cirrhosis/Cancer Risk |
High-Risk Groups |
Overall Danger Level |
|---|
| A |
❌ None |
❌ No cancer link |
Pregnant women (acute liver failure) |
🔹 Low |
| B |
✅ 5–10% in adults, up to 90% in infants |
✅ Cirrhosis, liver cancer |
Newborns from infected mothers, unvaccinated adults |
🔺 High |
| C |
✅ 70–85% become chronic |
✅ Major cause of cirrhosis and liver cancer |
IV drug users, unprotected sex |
🔺 High |
| D |
✅ Only in co-infection with HBV |
✅ Worse than HBV alone |
People already infected with HBV |
🔴 Very High |
| E |
❌ Rarely chronic (only in immunocompromised) |
❌ Not a cancer risk |
Pregnant women (severe acute hepatitis) |
🔸 Medium-Low |
Summary:
- Hepatitis B and C are the most dangerous types in Thailand due to chronic infection and liver cancer risk
- Hepatitis D is the most severe clinically but less common
- A and E are acute and self-limiting, except for hepatitis E in pregnancy
How Are Hepatitis Infections Diagnosed?
A diagnostic workflow to determine infection type, stage, and liver damage
Initial Clinical Evaluation
- Medical History & Physical Exam
- Ask about risk factors (e.g., needle sharing, unprotected sex, transfusion)
- Check for jaundice, enlarged liver, tenderness
- Liver Function Tests (LFTs)
- AST, ALT, ALP, bilirubin levels
- Acute hepatitis: significantly elevated AST/ALT
Specific Viral Serologic Tests
| Virus |
Acute Infection |
Chronic / Immunity Markers |
|---|
| A |
IgM anti‑HAV |
IgG anti‑HAV (past infection or vaccination) |
| B |
HBsAg (<6 mo), IgM anti‑HBc |
HBsAg, anti‑HBs, anti‑HBc; possibly HBeAg, HBV DNA |
| C |
anti‑HCV initial, confirm with HCV RNA PCR |
HCV RNA quantifies viral load for monitoring |
| D |
anti‑HDV (IgM/IgG) if HBsAg positive |
HDV RNA (in specialized labs) |
| E |
IgM anti‑HEV for acute suspected cases |
HEV RNA in select settings |
Further Assessments
- Liver function: albumin, PT/INR, bilirubin to assess damage
- Fibrosis assessment: Ultrasound, FibroScan, APRI/FIB‑4 score
How to Treat Each Type of Hepatitis?
Once diagnosed, here’s what treatments to expect and how to support recovery across A–E.
| Type |
Main Treatment |
Treatment Duration |
Supportive Care |
|---|
| A |
Rest, hydration, nutrition (no antivirals) |
4–8 weeks |
Avoid alcohol, liver-toxic drugs |
| B |
Antivirals: Tenofovir or Entecavir |
Chronic cases or high viral load (≥ 6 months) |
Blood tests every 3–6 months, annual liver ultrasound |
| C |
DAAs: Sofosbuvir + Ledipasvir or Glecaprevir + Pibrentasvir |
8–12 weeks |
Monitor viral load, liver function, supplement B vitamins |
| D |
For coinfected with B: Pegylated Interferon, or add HBV antivirals |
6 months–1 year (co-treatment) |
Monitor HDV RNA, avoid liver toxins |
| E |
Like A: supportive care only |
4–6 weeks |
Avoid raw food, drink clean water |
Does Hepatitis Cure or Become Chronic?
| Type |
Cure Possible? |
Chance of Chronic Infection |
Notes |
|---|
| A |
✅ Yes, nearly all cases |
❌ No chronic form |
Immunity is lifelong |
| B |
✅ 90–95% recovery in adults |
✅ ~5–10% chronic; ~90% in infants |
Adults often clear; infants need attention |
| C |
❌ Most cases become chronic (70–85%) |
✅ High |
Treatment with DAAs is essential |
| D |
✅/❌ May clear if properly treated with HBV |
✅ Very high (40–90%) if untreated |
Must treat HBV concurrently |
| E |
✅ Clears in most |
❌ Rare chronic in immunocompromised |
Long-term immunity after recovery |
Key Takeaways:
- Types A & E: Almost always self-limiting; no chronic risk
- Type B: Usually self-limiting in adults, high chronic risk in infants
- Types C & D: Very high risk of chronic infection without treatment
Can Hepatitis Lead to Cirrhosis or Liver Cancer?
| Type |
Fibrosis |
Cirrhosis |
Liver Cancer (HCC) |
References |
|---|
| A |
❌ No fibrosis |
❌ No cirrhosis |
❌ No HCC |
Not documented in general population |
| B |
✅ 20–30% of chronic infections |
✅ Possible long-term |
✅ Key driver of HCC |
CDC, WHO |
| C |
✅ High, rapid fibrosis |
✅ 20–30% in chronic cases |
✅ 1–3% annual HCC risk in fibrotic patients |
WHO, PubMed |
| D |
✅ Faster, severe fibrosis in co-infection |
✅ More aggressive cirrhosis |
✅ 2–3X higher HCC risk |
HBV/HDV coinfection studies |
| E |
❌ No fibrosis |
❌ No cirrhosis |
❌ No HCC |
Except immunocompromised individuals |
Key takeaway:
- B, C, and D are high-risk groups for cirrhosis and liver cancer
- C is a leading cause of HCC in Thailand
- D, when combined with B, accelerates liver damage compared to B alone
- A and E do not typically cause these complications in otherwise healthy individuals
How to Prevent Hepatitis?
General Prevention Tips for All Types
- Frequent hand-washing, especially before meals and after using the restroom (critical for A & E)
- Avoid sharing personal items like needles, razors, toothbrushes; always use new condoms
- Eat clean, thoroughly cooked foods; avoid suspect meats or street food
- Limit alcohol and avoid liver-toxic drugs to keep your liver strong
Prevention by Virus Type
| Type |
Specific Prevention Measures |
|---|
| A & E |
Drink safe water and ensure food (esp. produce) is well-cooked |
| B & C |
Use condoms, avoid needle-sharing, avoid blood-contaminated items |
| D |
Prevent HBV (vaccination/protection) to reduce HDV risk |
| E |
Avoid undercooked pork, game, and unclean water sources |
Available Vaccinations
- HAV vaccine – 2-dose series, protects against hepatitis A
- HBV vaccine – 3-dose series, prevents hepatitis B and indirectly reduces HDV risk
- No vaccines yet available for C, D, or E – behavioral prevention is essential
Should You Get Hepatitis Vaccines and When?
Guidelines for hepatitis A and B vaccinations, schedules, and who should receive them
Current Hepatitis Vaccines
| Type |
Vaccine |
Vaccination Schedule |
Who Should Get It? |
|---|
| A |
HAV vaccine |
2 doses — initial dose and second dose 6–12 months later |
Children, travelers to endemic regions, high-risk groups (e.g., MSM) |
| B |
HBV vaccine |
3 doses — at 0, 1, and 6 months |
Newborns*, non-immune adults, healthcare and high-risk workers |
| D |
— No direct vaccine; protection comes via HBV immunization |
— |
Those who are HBsAg positive should be vigilant |
*In Thailand, HBV vaccine is part of the EPI (Expanded Program on Immunization) for newborns. A booster is recommended for adolescents and high-risk adults.
How Should You Care for Yourself After Getting Hepatitis?
Basic Self-Care
- Get enough rest – Aim for 7–8 hours of sleep per night.
- Stay hydrated and eat well – Focus on vegetables, fruits, and easily digestible foods
- Avoid alcohol and liver-straining medications (e.g., high-dose acetaminophen unless prescribed)
- Engage in light exercise such as walking or yoga to support immunity
Tailored Care by Hepatitis Type
| Type |
Self-Care Recommendations |
|---|
| A & E |
Usually just rest and nutrition; monitor symptoms weekly |
| B, C, D |
Adhere to treatment plan; get blood tests every 3–6 months, annual liver ultrasound, maintain healthy weight, avoid fatty foods |
When Should You Urgently See a Doctor?
Seek urgent medical care if you experience:
- Deep jaundice – indicates severe liver dysfunction
- Intense right‐upper‐quadrant abdominal pain + jaundice
- Persistent vomiting, especially with blood or black stool
- Very dark urine – a sign of intense liver inflammation
- Severe fatigue + ongoing nausea/appetite loss for several days
- Easy bleeding, such as gum bleeding or nosebleeds
- Drowsiness, confusion, or sudden disorientation – signs of acute liver failure
- Pregnant women with abdominal pain or contractions might signal acute liver failure
Frequently Asked Questions (FAQ) about Hepatitis
Q1: “Can I get hepatitis from kissing?”
- ✔️ HBV & HCV: Very low risk unless there’s blood or oral lesions present
- ❌ HAV, HEV & HDV: Not transmitted via kissing
Q2: “What does positive anti‑HBc mean?”
- Indicates past exposure to HBV; you may have immunity or be a carrier
- Follow-up tests: HBsAg, anti‑HBs, HBV DNA to clarify status
Q3: “If pregnant and infected, will the baby be at risk?”
- HBV & HDV: Can transmit at birth—administer HBIG + HBV vaccine within 12 hours of delivery
- A, C, E: Very low to negligible mother-to-child transmission
Q4: “Can I drink alcohol if I have hepatitis?”
- 🚫 No alcohol during active infection—adds liver strain and accelerates fibrosis
Q5: “If HCV RNA is undetectable, am I cured?”
- ✅ Yes—SVR12 (undetectable virus 12 weeks post-treatment) equals cure for hepatitis C
Q6: “Do I need lifelong meds for HBV?”
- Not always—if your viral load is low and liver enzymes are normal, you may be monitored
- Otherwise, antivirals are prescribed based on severity and expert guidelines
Q7: “Do I need to check anti‑HBs after vaccination?”
- Yes—test anti‑HBs 1–2 months post-series; levels ≥ 10 IU/L indicate immunity
- Boosters recommended if levels are low
Q8: “Can I donate blood after having hepatitis?”
- ❌ No—not during infection or after recovery; blood banks have strict exclusion rules
Q9: “Can I take painkillers with HCV?”
- Avoid liver-toxic meds (e.g., high-dose acetaminophen)
- Consult your doctor or pharmacist for safer alternatives
Q10: “If I have chronic hepatitis, can I still have children?”
- B & C: Pregnancy is possible—consult specialists, monitor viral load, and plan antiviral therapy as needed
- Pre-conception evaluation is highly recommended
Quick Hepatitis A–E Summary (1-Minute Guide)
A compact table with essential facts about each hepatitis type
| Type |
Transmission |
Chronic |
Cirrhosis/Cancer |
Prevention |
Vaccine |
|---|
| A |
Contaminated food/water |
❌ |
❌ |
Hand hygiene, clean water |
✔️ HAV |
| B |
Blood, sex, mother-child |
✅ |
✅ |
Safe sex, avoid needles |
✔️ HBV |
| C |
Blood via shared needles |
✅ |
✅ |
Don’t share needles |
❌ |
| D |
Same as B (requires HBV) |
✅ |
✅ |
Prevent B |
❌ |
| E |
Raw food, water contamination |
❌ |
❌ |
Cook thoroughly, clean water |
❌ |
