What is it?

Overview

What Is It?
The hepatitis viruses all cause acute inflammation of the liver, and some infections related to hepatitis B and C may become chronic.

You've probably heard warnings about hepatitis, a category of viral infections that can cause serious liver damage and even lead to death. Hepatitis literally means inflammation of the liver ( hepa = liver; it is = inflammation).

If you're having trouble keeping up with the alphabet soup of the different types of the hepatitis virus you're not alone. There are five main types: A, B, C, D and E. For the most part, however, you need to concern yourself only with hepatitis A, hepatitis B and hepatitis C.

The hepatitis viruses all cause acute inflammation of the liver, and some infections related to hepatitis B and C may become chronic. Although many hepatitis infections do not cause symptoms, in those that do, the leading symptoms are:

• jaundice (yellowing of the skin and eyes)
• fatigue or malaise
• abdominal pain
• appetite loss
• nausea
• diarrhea
• vomiting

The good news is that vaccines against hepatitis A and hepatitis B have been introduced in the last few decades. The U.S. Centers for Disease Control and Prevention (CDC) recommends that all children be vaccinated against hepatitis B at birth, and that those at risk for either infection get the appropriate vaccinations.

Hepatitis A

Hepatitis A is an acute liver disease caused by the hepatitis A infection that lasts for a few weeks to a few months. It does not lead to chronic liver infection. According to the CDC, there were about 25,000 new hepatitis A infections in 2007. In 2006, the incidence of hepatitis A was 1.2 per 100,000, the lowest number ever recorded. Symptoms of hepatitis A usually do not appear until you have had the virus for a month and include fatigue, nausea and vomiting, abdominal pain or discomfort, appetite loss, low-grade fever, dark urine, muscle pain, itching and yellowing of the eyes and skin (jaundice). Not everyone with the infection develops symptoms. Symptoms usually clear up within two months but may last as long as six months.

You can contract hepatitis A via the following:

• Drinking contaminated water
• Eating raw shellfish from polluted water
• Close contact with someone who is infected
• Sexual intercourse with someone who has the virus
• Eating food that was handled by someone who didn't wash his or her hands thoroughly after using the bathroom
• Receiving a blood transfusion with blood contaminated with hepatitis A (this is rare)

You are at an increased risk of contracting hepatitis A if you:

• Travel to regions with high rates of hepatitis A
• Use illicit drugs (injected or non-injected)
• Live with another person who has hepatitis A
• Work in a setting where you might be exposed to the virus
• Receive clotting factor concentrates for a medical condition

For most women, the biggest risk factors are sexual or household contact with an infected person, or travel to countries where hepatitis A is common.

For hepatitis A, vaccination is recommended for the following people:

• Children age one or who did not receive the vaccination at age one
• Travelers to areas with increased rates of hepatitis A
• Men who have sex with men
• Injecting and non-injecting illicit drug users
• People who receive clotting factor concentrates as part of their medical treatment
• People with chronic liver disease

Hepatitis B

Hepatitis B is a liver disease caused by the hepatitis B virus that ranges from an acute mild illness lasting for a few weeks to a serious chronic illness that can eventually lead to liver disease or cancer. Many people with the infection have no symptoms; when symptoms occur, they may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain and jaundice. Hepatitis B rates have declined by 82 percent since 1990, when the vaccine was first given to children. About six to 10 percent of people who are infected with hepatitis B develop chronic infection. Approximately 800,000 to 1.4 million people are chronically infected with hepatitis B in the United States , and about 2,000 to 4,000 per year die from the disease.

One leading mode of transmission is unsafe sex. The virus is also spread by shared needles, from a mother to her newborn, sharing razors or toothbrushes with an infected person, direct contact with blood or open sores of an infected person or exposure to contaminated blood via needle sticks or other sharp instruments. Screening of blood donors has virtually eliminated transmission via blood transfusion. All pregnant women in the United States should be screened for hepatitis B. If infected, the baby will need to receive specific hepatitis B immune globulin and be vaccinated at birth.

Vaccination against hepatitis B is also recommended for:

• All infants, starting with the first dose of hepatitis B vaccine at birth
• All children under age 19 who have not been vaccinated
• People whose sex partners have hepatitis B
• Sexually active people who are not in long-term mutually monogamous relationships
• Anyone diagnosed with a sexually transmitted disease
• Men who have sex with men
• Sex contacts of infected persons
• Injection drug users
• Household contacts of chronically infected persons
• Health care and public safety workers at risk for contact with contaminated blood or bodily fluids
• People with end-stage renal disease
• Residents and staff of facilities for developmentally disabled persons
• People with chronic liver disease
• Travelers to areas with moderate or high rates of hepatitis B infection
• People with HIV infection
• Anyone who wishes to be protected against hepatitis B

Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus. Acute infection rarely causes symptoms. Most often, hepatitis C acts as a chronic condition that can lead to liver disease or cancer. An estimated 3.2 million people are chronically infected with hepatitis C in the United States , and about 55 to 85 percent of people who contract hepatitis C develop chronic infection. Most people with hepatitis C don't realize they are infected, and they don't become aware of their infections until liver damage shows up decades later. When symptoms do occur, they include fatigue, fever, nausea or poor appetite, muscle and joint pains and tenderness in the area of the liver. Hepatitis C causes up to 10,000 deaths a year, due to complications of cirrhosis and liver cancer. Treatments are available but they are not effective in all patients. Unfortunately, there isn't yet a vaccination for hepatitis C.

Hepatitis C poses serious health problems for some people, but for the 15 to 45 percent who are able to clear the virus out of their bodies without treatment, there are no long-term consequences. According to the CDC, out of 100 people who become infected with hepatitis C, 60 to 70 will go on to develop chronic liver disease and five to 20 will go on to develop cirrhosis over a period of 20 to 30 years. The annual incidence of liver decompensation (advanced liver disease with complications) or liver cancer in people with cirrhosis is 1 to 5 percent.

You should be tested for hepatitis C if you fit into one of the following categories:

• You are a current or former IV drug user.
• You were treated for a blood clotting condition before 1987.
• You received a blood transfusion or organ transplant before July 1992.
• You are on long-term hemodialysis treatment.
• You have abnormal liver tests or liver disease.
• You work in health care or public safety and were exposed to blood through a needle stick or other sharp object injury.
• You are HIV positive.

Hepatitis D

Hepatitis D only occurs in people with hepatitis B, and it can make an existing hepatitis B infection worse. Luckily, hepatitis D is uncommon, affecting only 5 percent of people with hepatitis B. It leads to chronic liver disease in about 10 percent of people who have it. Because hepatitis D only occurs in people with hepatitis B, you can protect yourself against both by getting the hepatitis B vaccine.

Hepatitis E

Hepatitis E virus is similar to the hepatitis A virus in mode of transmission and the duration of the disease, although it tends to occur as part of large water- or food-borne epidemics. Hepatitis E spreads through contact with food or water contaminated by feces from an infected person. Rare in the United States , the infection usually clears up after several weeks to a few months. At risk are international travelers, people living in areas where hepatitis E outbreaks are common and people who have sex or live with an infected person. To limit risk of hepatitis E exposure, avoid tap water when traveling internationally and practice good hygiene and sanitation.

Diagnosis

Diagnosis

Hepatitis A

Blood tests are required to diagnose hepatitis A. Your doctor may also discuss your symptoms as part of your diagnosis. Symptoms of hepatitis A usually do not appear until you have had the virus for a month and include fatigue, nausea and vomiting, abdominal pain or discomfort, appetite loss, low-grade fever, dark urine, muscle pain, itching and jaundice. Not everyone with the infection develops symptoms, however. Symptoms usually clear up within two months but may last as long as six months.

Acute hepatitis A is diagnosed by a positive blood test for IgM antibody against hepatitis A virus (IgM-HAV-Ab) . If you have been previously exposed to the hepatitis A virus but have cleared the infection and now have long-lasting immunity, then the blood test will be positive for IgG antibody against hepatitis A virus (IgG-HAV-Ab).

Hepatitis B

Symptoms of hepatitis B usually set in two to three months after infection and may include abdominal pain, dark urine, loss of appetite, joint pain, nausea and vomiting, weakness and fatigue and jaundice.

Because hepatitis B can start to damage the liver before symptoms set in, physicians sometimes will test healthy people for the infection. People who may want to consider being tested for hepatitis B include:

• Those who live with someone infected with hepatitis B
• People with a sexual partner with hepatitis B
• IV drug users
• Anyone with an unexplained abnormal liver enzyme test
• Babies born to mothers with hepatitis B
• Immigrants and children adopted from areas of the world where hepatitis B is more prevalent, such as Eastern Europe, Asia and the Pacific Islands
• People on kidney dialysis
• Pregnant women
• People who have one or more parents from an area of the world where hepatitis B is more common
• Men who have sex with men
• Prison inmates

There are several blood tests available to test for hepatitis C. These tests may help to determine whether or not you've been infected, measure the viral load and look at the genetic makeup of the virus to best target therapy.

• Blood tests:
  • Acute hepatitis B is diagnosed by a positive blood test for IgM antibody against the core antigen of hepatitis B virus (IgM-HBc-Ab). Patients with acute infection typically also test positive for hepatitis B surface antigen (HBsAg) and hepatitis B DNA (HBV DNA).
  • Chronic hepatitis B is characterized by positive tests for HBsAg and IgG antibody against hepatitis B core antigen (IgG-HBc-Ab). Patients with chronic infection and active viral replication typically test positive for HBV DNA and e antigen (HBeAg), although some patients may be HBeAg negative and HBV DNA positive.
  • Clearance of hepatitis B after acute infection and development of long-lasting immunity is defined by negative HBsAg and positive IgG-HBcAb and HBsAb.
  • HBV DNA is quantified before and during treatment to monitor effectiveness of treatment. HBV DNA level is also used to select patients for treatment and to stratify risk for development of liver cancer.
  • HBV genotypes may be useful in predicting response to peginterferon, a powerful antiviral drug used for treating chronic hepatitis B and C.
• Additional tests that may be used to determine the severity of a hepatitis C infection:
  • Liver function blood tests to help assess the degree of damage your liver has suffered due to the hepatitis B infection.
  • A liver biopsy to determine your liver health.

Hepatitis C

In its early stages, hepatitis C usually produces no symptoms. When symptoms set in, they are often mild and include fatigue, fever, nausea, loss of appetite, muscle and joint pains and tenderness in the area of your liver. Because hepatitis C can eventually cause cirrhosis of the liver and liver cancer if left untreated, some people are encouraged to seek testing, even if they have no symptoms. These people include:

• Injection drug users, even those with remote past histories
• People who received blood transfusions or solid organ transplants before 1992
• People who received clotting factors before 1987 (mostly hemophiliacs)
• Dialysis patients
• People who are HIV positive
• Infants born to mothers with hepatitis C
• Health care workers exposed on the job
• People who have received a piercing or tattoo in an unclean environment using unsterile equipment

There are several blood tests available to test for hepatitis C. These tests may help to determine whether or not you've been infected, measure the viral load and look at the genetic makeup of the virus to best target therapy.

• Blood tests include:
  • Acute hepatitis C is diagnosed by seroconversion from negative to positive HCV Ab after a documented exposure. A presumptive diagnosis may also be based upon an acute elevation in liver enzymes and positive HCV RNA in a patient with risk factor for recent exposure to HCV.
  • Chronic hepatitis C is characterized by a history of risk factor for exposure to HCV and positive tests for HCV Ab and HCV RNA.
  • Clearance of HCV is characterized by positive HCV Ab and negative HCV RNA (on at least two or more tests over three months or more).
  • HCV RNA is quantified before and during treatment to monitor effectiveness of treatment.
  • HCV genotypes are useful for predicting likelihood of responding to treatment.
• Additional tests that may be used to determine the severity of a hepatitis C infection:
  • Liver function blood tests to help assess the degree of damage your liver has suffered due to the hepatitis B infection.
  • A liver biopsy to determine your liver health.
  • Noninvasive tests of fibrosis or function, such as serum fibrosis markers, hepatic elastography, or metabolic and clearance tests.

Treatment

Treatment

Hepatitis A

Hepatitis A differs from hepatitis B and hepatitis C in that it doesn't usually cause chronic infection or chronic liver disease. Almost all cases resolve after a month or two. Treatment for the infection involves easing the symptoms and may include rest and time away from work or school to cope with the fatigue; eating small meals and soft, easily digestible foods to deal with the nausea; and eliminating alcohol and any medications that may tax your liver while it is healing. Because symptoms of hepatitis A can be sudden and severe, hospitalization may be necessary for patients who become dehydrated from vomiting or who have severe hepatitis. People who have had contact with someone with acute hepatitis A may require treatment with immune serum globulin and/or hepatitis A vaccine.

Hepatitis B

There is no specific treatment for acute hepatitis B. In severe cases, your health care provider may recommend nucleoside/nucleotide treatment, but this treatment is unproven.

Anyone who has been in contact with someone who has acute hepatitis B may require treatment with hepatitis B immune globulin and/or hepatitis B vaccine. If you suspect you've just been infected with the hepatitis B virus, call your doctor right away. An injection of hepatitis B immune globulin within 24 hours of exposure can help protect you against the virus.

If you get to your doctor after 24 hours and he or she determines that your infection is acute and likely to resolve on its own, your treatment will involve easing your symptoms. You may also receive follow-up blood tests to make sure the virus has left your body.

If your doctor determines that your hepatitis B infection is chronic, he or she may prescribe medications to help your body fight the virus and prevent liver damage. Not everyone with chronic infection needs medication.

Seven drugs have been approved for chronic hepatitis B treatment. They include:

• Interferon alpha (Intron A): A drug given by injection several times a week for six months to a year.
• Pegylated interferon (Pegasys): A drug given by injection once a week for six months to a year.
• Lamivudine (Epivir-HBV, Zeffix, Heptodin): A pill taken once a day for a year or longer.
• Adefovir dipivoxil (Hepsera): A pill taken once a day for a year or longer.
• Entecavir (Baraclude): A pill taken once a day for one year or longer.
• Telbivudine (Tyzeka, Sebivo): A pill taken once a day for one year or longer.
• Tenofovir (Viread): A pill taken once a day for one year or longer.

Pegylated interferon (also known as peginterferon) therapy is effective in up to 25 percent of people infected with HBV genotype A but is less effective in other genotypes and is not recommended for people with cirrhosis.

Nucleosides (lamivudine, telbivudine, entecavir) and nucleotides (adefovir, tenofovir) are effective in most patients, including patients with cirrhosis, but long-term treatment for years is often required.

If your liver is severely damaged as a result of a chronic hepatitis B infection, you may need a liver transplant, where a surgeon removes your damaged liver and replaces it with a healthy one.

As a preventive measure, you should avoid alcohol and cigarettes. In addition, talk to your doctor before taking any prescription or over-the-counter medication, including herbal remedies.

Hepatitis C

Hepatitis C is usually treated with the combination of peginterferon with ribavirin, as described below:

• Peginterferon (PegIntron or Pegasys): A medication given by injection, once weekly.
• Ribavirin: Antiviral pills taken twice daily.

In addition, you should get plenty of rest and avoid any substances that are toxic to the liver, such as alcohol and cigarettes. Discuss any over-the-counter or prescription remedies with your health care professional before taking them.

Also, people with hepatitis C should get vaccinated against hepatitis A and B.

Common side effects from treatment include flu-like symptoms, such as muscle aches, fever, chills and headaches. Often these can be managed by taking interferon at night or by lowering the dosage. Acetaminophen or similar agents can also reduce flu-like symptoms if taken before treatment. Other side effects include depression, hair loss and irritability.

Prevention

Prevention

Because chronic viral hepatitis is often a "silent infection," it is difficult to know who is infected. Avoiding unsafe sex and exposure to blood are good preventive measures. Prior to availability of testing, transfusion of blood or blood products was a common mode of transmission of both hepatitis B and C. Today, with sensitive and specific testing of blood donors, the risk is dramatically reduced to nearly zero. Using condoms for intercourse or oral sex on a man also protects you against other sexually transmitted diseases. However, the best protection comes from vaccines. Safe and effective vaccines are available for hepatitis A and B, and research on a vaccine for hepatitis C is under way.

Hepatitis C can spread via sexual activity, but the risk of transmission through sexual contact is believed to be low. This risk is higher for people with multiple sex partners, those who have a sexually transmitted disease, people who engage in rough sex and individuals who are HIV positive. More research is needed to better understand exactly how hepatitis C spreads through sexual contact.

Another unproven but suspected mode of transmission for hepatitis is tattooing. Be certain that disposable equipment and sterile techniques are used if you decide to get a tattoo.

Hepatitis A

According to the CDC, the best way to prevent hepatitis A is to be vaccinated against the infection. The hepatitis A vaccine is recommended for all children at age one year, for travelers to certain countries where hepatitis A is more prevalent and for people at high risk for the infection, including men who have sex with men, IV drug users, people with chronic liver disease, such as hepatitis B or C, people treated with clotting factor concentrates and people who work with the hepatitis A virus.

The hepatitis A vaccine is given as two shots, six months apart. A combination hepatitis A and B vaccine is also currently available for adults 18 years of age and older, given as three shots over six months.

The hepatitis A vaccine is safe and effective, with protection beginning two to four weeks after the first injection.

In addition, because hepatitis A spreads via fecal matter, frequent hand washing with soap and warm water, particularly after using the bathroom, changing a diaper or preparing food, can help prevent hepatitis A.

Hepatitis B

The primary way people become infected with hepatitis B is through contact with blood or body fluids of an infected person. For example, you can become infected by having sex or sharing needles with an infected person. In many developing countries, the most common means of infection is mothers passing the virus to their infants during childbirth.

Hepatitis B is not spread through food, water or casual contact. Although the virus is found in saliva, kissing is not considered a high risk. The greatest risk of infection from sexual contact is vaginal and anal sex. Having multiple partners increases that risk. Oral sex also can transmit the virus but not as efficiently as vaginal or anal sex. To help prevent infection, make sure you know the hepatitis B (and other STD ) status of all your sexual partners and use a latex condom every time you have sex.

As with hepatitis C, any procedure or activity that puts you in direct contact with another person's blood puts you at risk for hepatitis B. Many people were infected through blood transfusions before hepatitis B was screened in blood donors. Today, however, infection from transfusion is very rare. It is possible to get hepatitis B from sharing razors, toothbrushes, pierced earrings and nail clippers, but the risk is low. Injection drug users get hepatitis B and C when sharing used syringes and needles because traces of a user's blood often remains inside the equipment. Tattooing and, possibly, body piercing can spread the virus if needles are reused without sterilization.

Because of the prevalence of hepatitis B, prevention through vaccination is recommended for all babies at birth and all children ages 19 and younger who have not been vaccinated. Adults who are at risk also should be vaccinated.

The hepatitis B vaccine prevents both infection and the complications related to the infection. It is given in a series of three to four injections over six months. The vaccine offers greater than 90 percent protection against hepatitis B, and it is completely safe. Since it was introduced in 1982, more than 100 million people have received the hepatitis B vaccine in the United States , and no serious side effects have been reported. The injections cause only mild soreness in the arm. Side effects other than fever and headache are rare.

A combination hepatitis A and B vaccine is currently available for adults 18 years of age and older, given as three shots over six months.

Hepatitis C

No vaccine is available to prevent hepatitis C. To avoid the disease, you must control risk factors. Currently, the most common ways of getting hepatitis C are injecting or snorting illegal drugs with shared equipment, tattooing or body piercing with unsterilized instruments and using an infected person's toothbrush or razor.

Hepatitis C can spread via sexual activity, but the risk of transmission through sexual contact is believed to be low. This risk is higher for people with multiple sex partners, those who have a sexually transmitted disease, people who engage in rough sex and individuals who are HIV positive. More research is needed to better understand exactly how hepatitis C spreads through sexual contact. In the meantime, to help prevent infection, make sure you know the hepatitis C (and other STD ) status of all your sexual partners and use a latex condom every time you have sex.

Hepatitis C is not spread by casual contact, such as hugging or kissing, or by sharing eating utensils or coughing.

The risk of a hepatitis C-infected mother transmitting the virus to her infant is approximately 4 percent. Risk increases in mothers who are HIV-positive. There is no evidence that breast-feeding spreads hepatitis C.

Facts to Know

Facts to Know

1. About 3.2 million Americans have chronic hepatitis C infection. Most people with hepatitis C do not know they are infected because they do not have symptoms. Hepatitis C causes up to 10,000 deaths annually from complications of cirrhosis of the liver or liver cancer and is the leading cause of liver transplants.

2. Although up to 85 percent of people infected with hepatitis C develop chronic liver disease, more than half will have no symptoms. Symptoms can be delayed for up to 30 years.

3. Chronic hepatitis C is usually treated with a combination of peginterferon and ribavirin.

4. About 15 to 25 percent of people with chronic hepatitis B develop serious liver diseases such as cirrhosis and liver cancer. About 2,000 to 4,000 people die from hepatitis B-related liver disease per year.

5. Thirty percent of adults with acute hepatitis B infection never show symptoms. Most adults, up to 94 percent, will develop antibodies and clear the infection. The risk of chronic infection is greater in children who become infected—up to 50 percent. Those who don't clear the infection develop chronic infection and can infect others for the rest of their lives.

6. As many as 1.4 million Americans have chronic hepatitis B infection.

7. Hepatitis B is highly contagious. Experts estimate it is up to 100 times easier to become infected from a single exposure than from a single exposure to HIV.

8. Hepatitis B is not spread through food, water or casual contact. The greatest risk of infection is through sexual contact. Kissing is not considered a risk, although the virus is found in saliva.

9. Seven drugs have been FDA-approved as an effective therapy for hepatitis B.

10. Hepatitis A is most commonly transmitted through fecal-oral contact, either by person-to-person transmission from household contact with contaminated objects and materials or through contaminated food or water. For example, you can get hepatitis A by changing the diaper of a baby who is infected with the virus and not cleaning up properly (disinfecting changing surfaces and washing your hands) or by drinking contaminated water while traveling. Fruits, vegetables, shellfish and other foods that are eaten raw can transmit the virus if they were processed with contaminated water. Hepatitis A is less common in the United States than in developing countries such as some parts of Mexico , Africa , Southeast Asia , Haiti and the Dominican Republic.

11. Hepatitis A, which reproduces in the liver and is shed in the feces, causes an infection that produces complete immunity so that a person never becomes infected again or has symptoms. Also, a person is infectious for a short time, so transmission conditions have to be just right for an outbreak to occur.

Questions to Ask

Review the following Questions To Ask about hepatitis so you're prepared to discuss this important health issue with your health care professional.

1. If I test positive for hepatitis, should my partner also be tested?

2. How can I avoid passing hepatitis to my children? Can I breastfeed if I have hepatitis?

3. If I have hepatitis C, does it make sense to get vaccinated for hepatitis A or hepatitis B?

4. If I have chronic hepatitis C, do I need a liver specialist to oversee my care?

5. How much will treatment for chronic hepatitis C cost per year?

6. Do I need to refrain from sexual contact before I have completed the hepatitis B vaccine schedule?

7. How long will a vaccine protect me from hepatitis A and B?

8. Are the drugs used for treating hepatitis B and C safe, and what happens if I accidentally take too much?

9. What happens if I am infected with hepatitis but never get treated? Will it go away on its own?

Key Q&A

Key Q&A

1. Is the hepatitis B vaccine safe?

   The vaccine for hepatitis B has been shown to be very safe when given to infants, children or adults, according to the U.S. Centers for Disease Control and Prevention (CDC), which monitors vaccine safety. More than 100 million people have received the hepatitis B vaccine in the United States , and no serious side effects have been reported. The most common side effects from hepatitis B vaccination are pain at the injection site and, rarely, mild to moderate headache and fever. Studies show that these side effects are reported no more frequently among those vaccinated than among persons not receiving the vaccine.

2. What puts me at greater risk of getting hepatitis B?

   Your risks increase if you have sex with an infected person, have multiple sexual partners, inject drugs, received blood clotting factors or transfusions before 1992 or travel to countries where hepatitis B is common—parts of Africa, Southeast Asia, the Middle East (except for Israel), Haiti and the Dominican Republic, for example.

3. How do I know if I need to get tested for hepatitis?

   Pay attention to your body. If you experience symptoms, such as eyes or skin turning yellow, a loss of appetite, nausea and fever or extreme fatigue for weeks or months, you may be infected with hepatitis. However, bear in mind that most infected persons have no symptoms and can pass the virus without knowing it. Therefore, you should get tested if you have put yourself at risk for the three main types of hepatitis — hepatitis A, hepatitis B, and hepatitis C. Blood transfusions before 1992 and injection drug use put you at greater risk for those three types. Unprotected sex with multiple partners is the biggest risk factor for hepatitis B or C infection.

4. If I am pregnant, can I give hepatitis to my baby?

   Yes. Hepatitis B and C can be transmitted during birth. Infected babies may carry the virus for the rest of their lives but most do well during childhood. Pregnant women are not routinely tested for hepatitis C because they have no greater risk than non-pregnant women. There is no evidence that hepatitis C is passed through breastfeeding. Only about four percent of hepatitis C-positive women pass the virus to their infants. All pregnant women should be tested for hepatitis B early in pregnancy. Vaccinating a baby at birth and giving it an immune globin (HBIG) shot can protect it from developing a hepatitis B infection from an infected mother.

5. Can hepatitis be spread by oral sex?

   It depends on the type of oral sex and the type of virus. Hepatitis C cannot be spread by oral sex. Hepatitis B can be spread by oral sex, but the risk is lower than with other types of sexual contact. Hepatitis A can be spread by oral-anal sex because it is harbored in feces.

6. Can someone be protected by the hepatitis A vaccine after being exposed to the virus?

   No. The hepatitis A vaccine is not licensed for use after someone has been exposed. However, an immune globulin shot can be administered and can often prevent an infection if the infection is caught in the first two weeks.

7. If my liver enzymes are normal, does that mean I am not infected with hepatitis C?

   No. People with chronic hepatitis C commonly have liver enzyme levels that go up and down. Some have liver enzyme levels that are normal for longer than a year even though they actually have a chronic infection. If your liver enzyme level is normal and you suspect chronic hepatitis C infection, have it rechecked several times over six to 12 months.

Organizations and Support

Organizations and Support

For information and support on coping with Hepatitis, please see the recommended organizations and Spanish-language resources listed below.

American Liver Foundation
Website: http://www.liverfoundation.org
Address: 75 Maiden Lane, Suite 603
New York, NY 10038
Hotline: 1-800-GO-LIVER (1-800-465-4837)
Phone: 212-668-1000

American Social Health Association (ASHA)
Website: http://www.ashastd.org
Address: P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
Email: info@ashastd.org

ASHA's STI Resource Center Hotline
Website: http://www.ashastd.org/herpes/herpes_hotline.cfm
Address: American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400

Association of Reproductive Health Professionals (ARHP)
Website: http://www.arhp.org
Address: 1901 L Street, NW, Suite 300
Washington, DC 20036
Phone: 202-466-3825
Email: arhp@arhp.org

CDC National Prevention Information Network
Website: http://www.cdcnpin.org
Address: P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 404-679-3860
Email: info@cdcnpin.org

Hepatitis B Foundation
Website: http://www.hepb.org
Address: 3805 Old Easton Road
Doylestown, PA 18902
Phone: 215-489-4900
Email: info@hepb.org

Hepatitis C Caring Ambassadors Program
Website: http://www.hepcchallenge.org
Address: 604 East 16th Street, Suite 201
Vancouver, WA 98663
Phone: 360-816-4186

Hepatitis Education Project
Website: http://www.hepeducation.org
Address: 911 Western Avenue, #302
The Maritime Building
Seattle, WA 98104
Phone: 206 732-0311
Email: hepinfo@hepeducation.org

Hepatitis Foundation International
Website: http://www.hepfi.org
Address: 504 Blick Drive
Silver Spring, MD 20904
Hotline: 1-800-891-0707
Phone: 301-622-4200
Email: hfi@comcast.net

Hep-C ALERT
Website: http://www.hep-c-alert.org
Address: 660 NE 125 Street
North Miami, FL 33161
Hotline: 1-877-HELP4HEP (1-877-435-7443)
Phone: 305-893-7992
Email: web@hep-c-alert.org

Hep C Connection
Website: http://www.hepc-connection.org
Address: 1325 South Colorado Boulevard
Building B, Suite 302
Denver, CO 80222
Hotline: 1-800-390-1202
Email: info@hepc-connection.org

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Website: http://www.cdc.gov/nchhstp
Address: Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov

National Hepatitis C Coalition
Website: http://nationalhepatitis-c.org
Address: P.O. Box 5058
Hemet, CA 92544
Hotline: 951-766-8238
Email: webmaster@nationalhepatitis-c.org

National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK)
Website: http://www.niddk.nih.gov
Address: Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892
Phone: 301-496-3583

The Association of Asian Pacific Community Health Organizations (AAPCHO)
Web Site: http://www.aapcho.org/site/aapcho/
Address: 300 Frank H Ogawa Plaza, Suite 620
Oakland, CA 94612
Phone: 510-272-9536
Email: nagrewe@aapcho.og

CDC - Department of Health and Human Services
Website: http://www.cdc.gov/spanish/enfermedades/hepatitis/
Address: Centros para el Control y la Prevención de Enfermedades
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-311-3435
Phone: 404-639-3311

The National Digestive Diseases Information Clearinghouse
Website: http://digestive.niddk.nih.gov/index_sp.htm
Address: 2 Information Way
Bethesda, MD 20892
Hotline: 1–800–891–5389
Email: nddic@info.niddk.nih.gov