Who Is Most Affected
In the United States, rates of new HBV infections are highest among adults aged 40-49 years, reflecting low hepatitis B vaccination coverage among adults at risk. The most common risk factor among people with new HBV infections is injecting drugs, related to the opioid crisis.
The highest rates of chronic hepatitis B infection in the United States occur among foreign-born individuals, especially people born in Asia, the Pacific Islands, and Africa. Approximately 70% of cases in the United States are among people who were born outside of the United States. CDC developed this map of the geographic distribution of hepatitis B around the world – PDF. Other groups who have higher rates of chronic HBV infection include people who inject drugs and men who have sex with men.
Hepatitis A And E Symptoms
Hepatitis A and hepatitis E present with similar symptoms. The diseases may develop without any signs or symptoms, or symptoms may be nonspecific. If you experience any of the symptoms below for more than two weeks, make an appointment with a gastroenterologist.
There are three phases of hepatitis A and E, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Fever
Safety Of Hepatitis Vaccines
Hepatitis vaccines have been given to millions of people all across the world without any evidence of serious side effects. “They’re very safe, and they’re extremely effective,” says Poland.
If you are not sure whether you should have hepatitis vaccines, talk with your doctor about your specific concerns.
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Hepatitis A Vaccine: Canadian Immunization Guide
For health professionals
Last partial chapter update
: The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN®, which is available on Health Canada’s Drug Product Database.
Last complete chapter revision: March 2018
Hepatitis A And B: Diseases Of The Liver
Hepatitis is an inflammation of the liver, most often caused by a viral infection. There are three common types of hepatitis caused by viruses: hepatitis A, hepatitis B, and hepatitis C. Vaccines have been developed that protect people from contracting hepatitis A and B. There is no vaccine for hepatitis C.
Hepatitis A and hepatitis B can be spread from person to person, although in different ways. They have similar symptoms, which include abdominal pain, fever, fatigue, joint pain, and jaundice .
Over the last 20 years, there has been a 90% decrease in cases of hepatitis A and an 80% decrease in hepatitis B cases in the U.S. Health experts believe that immunization efforts have led to this drop in rates of infection.
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How Is Hepatitis B Transmitted
Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.
In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.
Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.
Questions For Your Doctor
When you visit the doctor, you may want to ask questions to get the information you need to manage your hepatitis C. If you can, have a family member or friend take notes. You might ask:
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What Are Hepatitis B And Hepatitis C
Although hep A is a short-term illness that goes away completely, hepatitis B and hepatitis C can turn into serious long-term illnesses for some people. Teens and young adults are most at risk for getting these two viruses.
Hep B and C get passed from person to person the same ways that HIV does through direct contact with infected body fluids. Hepatitis B and C are even more easily passed in fluids and needles than HIV. This can happen through sexual contact and by sharing needles that have been contaminated with infected blood. Even when infected people don’t have any symptoms, they can still pass the disease on to others.
Sometimes mothers with hep B or C pass the virus along to their babies when they’re born. Hep B and C also can get passed in ways you might not expect such as getting a manicure or pedicure with unsterilized nail clippers or other dirty instruments. Getting a tattoo, if dirty needles are used, is another way someone can get hep B or C.
Common And Local Adverse Events
HA vaccine
HA vaccine is well tolerated. Reactions are generally mild and transient, and are usually limited to soreness and redness at the injection site. Other less frequent reactions include headache, irritability, malaise, fever, fatigue and gastrointestinal symptoms. Injection site reactions occur less frequently in children than in adults as do mild, systemic events . No significant difference in reactions is evident between initial and subsequent doses of vaccine or in the presence of pre-existing immunity.
HAHB vaccine
Refer to Hepatitis B Vaccine in Part 4 for information about HAHB vaccine.
Ig
Injection site reactions following receipt of standard human Ig include tenderness, erythema and stiffness of local muscles, which may persist for several hours. Mild fever or malaise may occasionally occur.
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Us Children And Adult Hepatitis B Vaccine Schedules
*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
3-Dose Vaccine Series for Children and Adults
The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.
There are four, 3-dose vaccine brands approved in the U.S.
- PreHevbrio PreHevbrio is only approved for adults age 18 and over.
2-Dose Vaccine Series
How Long Does It Last
Hepatitis A can last from a few weeks to several months.
Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%10% of older children and adults who get infected develop chronic hepatitis B.
Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.
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Who Should Be Vaccinated
Children
- All children aged 1223 months
- All children and adolescents 218 years of age who have not previously received hepatitis A vaccine
People at increased risk for hepatitis A
- International travelers
- Men who have sex with men
- People who use or inject drugs
- People with occupational risk for exposure
- People who anticipate close personal contact with an international adoptee
- People experiencing homelessness
People at increased risk for severe disease from hepatitis A infection
- People with chronic liver disease, including hepatitis B and hepatitis C
- People with HIV
Other people recommended for vaccination
- Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection
Any person who requests vaccination
There is no vaccine available for hepatitis C.
What Is Hepatitis A
Hepatitis A is a liver infection caused by the hepatitis A virus . Hepatitis A can be transmitted when a person ingests the virus from food, drinks, or other objects that have been contaminated by small amounts of stool from an infected person. This can happen through unwashed hands when an infected person prepares food, by close personal contact such as during sex, or caring for someone who is ill. HAV is highly contagious and can range from a mild illness lasting a few weeks to severe illness lasting several months. Unlike hepatitis B and C, HAV infection does not cause long-term, chronic liver disease. Although most people who get hepatitis A are only sick for a few weeks, in rare cases, HAV infection can cause liver failure and death. This is more common in individuals with existing liver disease and other illnesses often seen in homeless persons.
Most children under 6 years of age do not have symptoms when they get hepatitis A. Older children and adults will usually have symptoms. The symptoms will generally clear-up within 2 months of infection and may include:
- Fatigue
- Nausea
- Jaundice
Once a person becomes infected with HAV, the person develops antibodies that protect them from getting the virus again. The best way to prevent HAV infection is by getting vaccinated.
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How Is Hepatitis A Treated
There is no formal treatment for hepatitis A. Because its a short-term viral infection that goes away on its own, treatment is typically focused on reducing your symptoms.
After a few weeks of rest, the symptoms of hepatitis A usually begin to improve. To ease your symptoms, you should:
- avoid alcohol
What Are The Symptoms And Signs Of Viral Hepatitis
The period of time between exposure to hepatitis and the onset of the illness is called the incubation period. The incubation period varies depending on the specific hepatitis virus. Hepatitis A virus has an incubation period of about 15 to 45 days Hepatitis B virus from 45 to 160 days, and Hepatitis C virus from about 2 weeks to 6 months.
Many patients infected with HAV, HBV, and HCV have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu-like symptoms including:
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How Is Viral Hepatitis Spread
Hepatitis A and hepatitis E usually spread through contact with food or water that was contaminated with an infected person’s stool. You can also get hepatitis E by eating undercooked pork, deer, or shellfish.
Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone who has the disease. Hepatitis B and D may also spread through contact with other body fluids. This can happen in many ways, such as sharing drug needles or having unprotected sex.
International Hepatitis B Vaccine Schedules
*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
The hepatitis B vaccine is an injection that is generally given in the arm and as a three-dose series. The World Health Organization recommends a 0, 1, and 6-month vaccine schedule, though schedules may vary based on a countrys national immunization program. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection. Please note that the vaccine brand name, manufacturer and associated schedules for adults, children and infants may be unique to different countries, though there is a list of WHO prequalified vaccines.
3-Dose Vaccine Series for Infants
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth and to complete the vaccine series with additional shots at 1 month and 6 months of age. Beginning the hepatitis B vaccine at birth will ensure protection against hepatitis B for life.
3-Dose Vaccine Series for Children and Adults
4-Dose Combination Vaccine Series for Infants
Additional Resource Links:
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Do You Need Vaccinations Before Traveling Abroad
The CDC divides travel vaccinations into three categories: 1) routine, 2) recommended, and 3) required. The only vaccine classified as “required” by International Health Regulations is the yellow fever vaccination for travel to certain countries in sub-Saharan Africa and tropical South America.
“Routine” vaccinations are those that are normally administered, usually during childhood, in the United States. These include immunizations against:
- tetanus
How Is Hepatitis Diagnosed
To diagnose hepatitis, your health care provider:
- Will ask about your symptoms and medical history
- Will do a physical exam
- Will likely do blood tests, including tests for viral hepatitis
- Might do imaging tests, such as an ultrasound, CT scan, or MRI
- May need to do a liver biopsy to get a clear diagnosis and check for liver damage
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Is There A Vaccine For Hepatitis
There are vaccines for hepatitis A and hepatitis B that are available in the U.S. There is no vaccine for hepatitis C. Since you can only get hepatitis D if you have hepatitis B, getting the vaccine against B should protect you against hepatitis D. There is no FDA approved vaccine against hepatitis E, but vaccines against hepatitis E exist overseas .
How Is Viral Hepatitis Diagnosed
Diagnosis of viral hepatitis is based on symptoms and physical findings as well as blood tests for liver enzymes, viral antibodies, and viral genetic materials.
Symptoms and physical findings
Diagnosis of acute viral hepatitis often is easy, but the diagnosis of chronic hepatitis can be difficult. When a patient reports symptoms of fatigue, nausea, abdominal pain, darkening of urine, and then develops jaundice, the diagnosis of acute viral hepatitis is likely and can be confirmed by blood tests. On the other hand, patients with chronic hepatitis due to HBV and HCV often have no symptoms or only mild nonspecific symptoms such as chronic fatigue. Typically, these patients do not have jaundice until the liver damage is far advanced. Therefore, these patients can remain undiagnosed for years to decades.
Blood tests
There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material .
Liver enzymes: Among the most sensitive and widely used blood tests for evaluating patients with hepatitis are liver enzymes, called aminotransferases. They include aspartate aminotransferase and alanine aminotransferase . These enzymes normally are contained within liver cells. If the liver is injured , the liver cells spill the enzymes into the blood, raising the enzyme levels in the blood and signaling that the liver is damaged.
Examples of tests for viral antibodies are:
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What Do Doctors Do
A doctor who thinks someone may have hepatitis may ask questions like these:
- Has the person been around anyone who works in health care or childcare?
- Did the person stick himself or herself with a dirty needle or get a tattoo with a dirty needle?
- Did the person have contact with the bodily fluids of someone who has hepatitis?
- Did the person have a blood transfusion as a baby?
- Have any of the person’s family members had hepatitis?
- Could the person have eaten food that was contaminated with hepatitis A?
The doctor can order a blood test to see if someone has hepatitis and which type, then help the person get the right care.
How Do You Get Hepatitis B
The virus that causes hepatitis B lives in blood, semen, and other fluids in your body. You usually get it by having sex with someone who’s infected.
You also can get it if you:
- Have direct contact with infected blood or the body fluids of someone who’s got the disease, for instance by using the same razor or toothbrush as someone who has hepatitis B, or touching the open sores of somebody who’s infected.
- If you’re pregnant and you’ve got hepatitis B, you could give the disease to your unborn child. If you deliver a baby who’s got it, they need to get treatment in the first 12 hours after birth.
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