How Does Viral Hepatitis Spread?

A Keck Medicine of USC expert explains the different types of viral hepatitis and how they can be prevented.

Hepatitis is a general term describing inflammation of the liver. While hepatitis can be caused by genetic conditions, autoimmune disorders, fatty liver or alcohol, the most well-known types of hepatitis are viral in nature: hepatitis A, hepatitis B and hepatitis C.

Viral hepatitis can spread person-to-person, but not everyone who has viral hepatitis will know they have it. The only way to know is by being tested.

“That’s why I think everybody should ask their doctor about their liver health and about viral hepatitis testing,” says Norah Terrault, MD, a hepatologist with the USC Liver Health Center, part of Keck Medicine of USC.

By detecting hepatitis at an earlier stage, a person can take steps to manage their health and make sure they don’t pass it on to others.

Dr. Terrault explains the differences between the hepatitis types (A, B and C), how they spread and what treatments are available.

Hepatitis A

Hepatitis A is spread through contaminated food and drink. It causes an acute viral illness that lasts for a limited period.

“Infection is spread by the oral-fecal route, which means the person gets the virus from food or drinks contaminated by stool,” Dr. Terrault says. “This usually happens when a person infected with the hepatitis A virus is preparing food or drink but has not washed their hands, or if food or water has come into contact with waste materials some other way.”

This makes frequent and thorough handwashing crucial for people who handle or prepare food or drink for others — especially because it’s possible to have hepatitis A and not know it.

“Generally, people who get hepatitis A have mild symptoms, such as a little fatigue, a loss of appetite or mild nausea,” Dr. Terrault says. “Sometimes, they just think they have the flu.” Occasionally, people with a hepatitis A infection can become jaundiced, with yellow skin and eyes, and show other signs of liver failure. Rarely is liver damage from hepatitis A severe enough to require a liver transplant. (See Table 1 for a list of possible acute hepatitis symptoms.)

Patients who are jaundiced tend to have more severe symptoms and should seek medical attention.

There is no specific treatment for hepatitis A. “The focus is on treating the symptoms to help the patient get through the illness,” Dr. Terrault says. Additionally, it is important to protect others from becoming infected. A safe and effective vaccine is available, and family members or others living with the infected person should be vaccinated.

Hepatitis B

Hepatitis B is passed through blood and body secretions. It does not spread through casual contact.

“Among adults in the United States, hepatitis B is primarily spread through sexual contact,” Dr. Terrault says. “The second most common form of transmission is through blood-contaminated needles or equipment.” People who use drugs, particularly if sharing any needles or equipment, are at risk for getting hepatitis B. It is also possible to get hepatitis B through unsterile tattooing practices. “Generally, professional tattoo facilities use a new, sterile needle each time,” Dr. Terrault says. “However, home tattoos and tattoos that people receive in other settings, such as while incarcerated, are much riskier.”

Occasionally, a pregnant woman with hepatitis B will pass the disease to her baby through blood or the birth canal. To prevent this from happening, all women in the United States are recommended to be tested for hepatitis B during pregnancy. “If we identify a patient as having hepatitis B, there are many things we can do to protect the baby from becoming infected,” Dr. Terrault says.

Hepatitis B presents as an acute illness, though many will have few symptoms and not know that they have become infected. (See Table 1 for a list of possible acute hepatitis symptoms.)

Some of those who get infected with hepatitis B will develop a chronic liver disease. For people with chronic infection due to hepatitis B, highly effective treatments can help them feel better and reduce the risk of the disease progressing — but regular monitoring is needed.

Importantly, there is a way to be protected from getting hepatitis B. People of all ages should be tested to see if they have hepatitis B. For those without hepatitis B, getting the hepatitis B vaccine is the best means of preventing any infection in the future.

Hepatitis C

Like hepatitis B, hepatitis C is a bloodborne infection. There are, however, important differences between the two. For example, hepatitis C is not easily transmitted through sexual contact. (There is one exception of men who have sex with men who are HIV-positive.)

“The main form of hepatitis C transmission in the United States is through blood or blood-contaminated needles,” Dr. Terrault says. In the past, blood transfusions were a risk for hepatitis C, but now the blood supply is very safe, and this is no longer a risk. Currently, people who use drugs, particularly if sharing needles or equipment, are at high risk for getting hepatitis C. Any contact with blood-contaminated equipment is a risk, whether it is sharing nail clippers or razors or receiving medical care in other countries where best practices to prevent blood contamination are lacking. Also, similar to hepatitis B, unsterile tattooing practices are a risk.

“Also, if a mother is infected, she has a 5% risk of passing the virus to her child during childbirth.” Obstetricians take steps right after delivery to minimize this risk. Similar to hepatitis B, it is recommended that all pregnant women be tested for hepatitis C in pregnancy and that they be considered for treatment after delivery. Additionally, the babies born to mothers who are hepatitis C infected need to be tested to see if they are infected.

Like hepatitis B, hepatitis C can present as an acute illness with fatigue, loss of appetite, nausea, abdominal discomfort and jaundice. (See Table 1 for a list of possible acute hepatitis symptoms.) Importantly, many who develop an acute illness will go on to have a chronic infection and be at risk of liver complications in the future.

If a person is found to have hepatitis C (either during the acute illness phase or in the chronic illness phase), treatment should be undertaken. Curative treatments for hepatitis C are available and only require an eight to twelve week course. All people who are infected with hepatitis C are recommended to be treated.

Unlike hepatitis A and B, for which there are vaccines available to prevent infection, there is currently no vaccine for hepatitis C. For hepatitis C, prevention is key — for example, avoiding reuse of needles that might be contaminated with blood.

Know your status

As with any other communicable disease, a person who doesn’t know they have viral hepatitis is at risk of liver complications as well as passing the virus along to others. That’s why it’s crucial to know your status.

“People can and should ask their doctor if they’ve been tested for hepatitis B and C and know their hepatitis status,” Dr. Terrault says. “It’s a good idea to use your annual visit as an opportunity to make sure you have been tested at least once or to get tested again if you have a new sex partner, been exposed to unsterile needles or have engaged in behavior that could increase your risk of contracting the infection.” Those who find out they are infected with hepatitis B or C should seek information about treatment. These infections are treatable! For those without infection, discuss with your primary care doctor whether vaccination for hepatitis A and B is right for you.

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