More than 300 million people globally have viral hepatitis. Predominantly caused by hepatitis A, B, and C viruses, viral hepatitis continues to confer high levels of morbidity and mortality despite the availability of vaccines and advances in therapies. Symptom severity varies during acute infection, with management focused on stabilization and serial monitoring to ensure resolution of liver injury. Infection with hepatitis A virus is generally self-limited, with low but increasing rates of mortality and hospitalization due to factors such as poorer baseline health status, older age, and coexisting liver disease. About 95% of acute hepatitis B cases in adults resolve spontaneously; treatment is rarely needed in acute infection. In contrast, only about 25% of acute hepatitis C cases resolve spontaneously, and immediate initiation of treatment at diagnosis is recommended. Screening for hepatitis B and C is recommended for all adults. Hepatocellular carcinoma screening is recommended for those with hepatitis B and cirrhosis or specific risk factors, and for those with hepatitis C and advanced liver fibrosis or cirrhosis. Treatment of hepatitis B involves assessment of specific factors to determine antiviral need; the goal of treatment is suppression of viral replication, thereby reducing risks of liver disease progression and hepatocellular carcinoma. Curative medications are available for hepatitis C.
Moore RA II. Hepatitis Overview: Viral Hepatitis. FP Essent. 2026;566:15-24.
Case 2. EE is a 64-year-old man with persistent fatigue whose laboratory tests show an elevated aspartate transferase (AST) level of 92 U/L (1.54 μkat/L), an elevated alanine transferase (ALT) level of 66 U/L (1.10 μkat/L), and a low platelet count of 126 × 103/μL (126 × 109/L). He has hypertension that is well controlled with losartan. He underwent tattooing with nonsterilized equipment in his 20s and had a brief period of injection drug use at that time. He has had one female sex partner over the past 30 years. He drinks less than three alcoholic drinks per day. On examination, you note spider angiomas and mild hepatosplenomegaly without ascites. EE asks about next steps to address his liver inflammation.
Epidemiology, Presentation, and Prevention
Viral hepatitis, most often caused by hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV), is a significant source of morbidity and mortality in the United States and globally. More than 300 million people worldwide have viral hepatitis. Global mortality has continued to increase despite advances in treatment and availability of vaccines, with 1.3 million deaths occurring in 2022.1 About 83% of these deaths were caused by hepatitis B and 17% by hepatitis C. Characteristics of the three main types of hepatitis, along with vaccination recommendations and other preventive measures, are summarized in Table 1.2–6
Table 1 Viral Hepatitis Transmission and Prevention
| Type | Mode of transmission | Incubation period | Vaccine recommendations | Other preventive measures |
|---|---|---|---|---|
| Hepatitis A | Fecal-oral | 15-50 days | Routine childhood vaccination, risk-based vaccination in adulthood | Hand hygiene, avoiding shared use of supplies for injection and noninjection drug use |
| Hepatitis B | Blood, body fluids, mother-to-child transmission | 1-4 months | Routine childhood vaccination, routine adult vaccination for those ages 19-59 years, risk-based vaccination for those ages ≥ 60 years | Hepatitis B immune globulin with or without maternal antiviral therapy for prevention of mother-to-child transmission; condom use; avoiding shared use of injecting supplies; sterile tattooing and piercing practices |
| Hepatitis C | Blood, mother-to-child transmission | 2 weeks to 6 months | No vaccine available | Avoiding shared use of injecting supplies, condom use for anal intercourse, sterile tattooing and piercing practices |
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