ABC Table

The ABCs of Hepatitis
HEPATITIS A is caused
HEPATITIS B is caused by the Hepatitis B

virus (HBV)
HEPATITIS C is caused by the

Hepatitis C virus (HCV)
U.S. Statistics
Estimated 3,000 new infections

in 2012
Estimated 19,000 new infections in 2012

Estimated 1.2 million people with chronic HBV
infection
Estimated 22,000 new infections in 2012

Estimated 3.2 million people with chronic
HCV infection
Routes of
Transmission
Ingestion of fecal matter, even in

microscopic amounts, from:
Close person-to-person contact
with an infected person
Sexual contact with an infected
person
Ingestion of contaminated food
or drinks
Contact with infectious blood, semen, and other body

fluids primarily through:
Birth to an infected mother
Sexual contact with an infected person
Sharing of contaminated needles, syringes, or other
injection drug equipment
Needlesticks or other sharp instrument injuries
Contact with blood of an infected person

primarily through:
S haring of contaminated needles, syringes,
or other injection drug equipment
Less commonly through:
Sexual contact with an infected person
Birth to an infected mother
Needlestick or other sharp instrument injuries
Persons at Risk
Travelers to regions with

intermediate or high rates
of Hepatitis A
Sex contacts of infected
persons
Household members or
caregivers of infected persons
Men who have sex with men
Users of certain illegal drugs
(injection and non-injection)
Persons with clotting-factor
disorders
Infants born to infected mothers

Sex partners of infected persons
Persons with multiple sex partners
Persons with a sexually transmitted disease (STD)
Injection drug users
Household contacts of infected persons
Healthcare and public safety workers exposed to
blood on the job
Hemodialysis patients
Residents and staff of facilities for developmentally
disabled persons
Travelers to regions with intermediate or high rates
of Hepatitis B (HBsAg prevalence of 2%)
Current or former injection drug users

Recipients of clotting factor concentrates
before 1987
Recipients of blood transfusions or donated
organs before July 1992
Long-term hemodialysis patients
Persons with known exposures to HCV
(e.g., healthcare workers after needlesticks,
recipients of blood or organs from a donor
who later tested positive for HCV)
HIV-infected persons
Infants born to infected mothers
Incubation Period
15 to 50 days (average: 28 days)
Symptoms of
Acute Infection
Symptoms of all types of viral hepatitis are similar and can include one or more of the following: Fever Fatigue
Loss of appetite Nausea
Vomiting Abdominal pain Gray-colored bowel movements Joint pain Jaundice
Likelihood of
Symptomatic
Acute infection
<
10% of children < 6 years
have jaundice
4 0%50% of children age
614 years have jaundice
7 0%80% of persons > 14
years have jaundice
< 1% of infants < 1 year develop symptoms

5 %15% of children age 1-5 years develop symptoms
30%50% of persons > 5 years develop symptoms
Potential for
Chronic Infection
None
Among unimmunized persons, chronic infection

occurs in >90% of infants, 25%50% of children
aged 15 years, and 6%10% of older children
and adults
75%85% of newly infected persons

develop chronic infection
15%25% of newly infected persons clear
the virus
Severity
Most persons with acute disease

recover with no lasting liver
damage; rarely fatal
M
ost persons with acute disease recover with no
lasting liver damage; acute illness is rarely fatal
1 5%25% of chronically infected persons develop
chronic liver disease, including cirrhosis, liver failure,
or liver cancer
1 ,800 persons in the United States die with HBVrelated liver disease as documented from death
certificates
Acute illness is uncommon. Those who do

develop acute illness recover with no lasting liver
damage.
60%70% of chronically infected persons
develop chronic liver disease
5%20% develop cirrhosis over a period of
2030 years
1%5% will die from cirrhosis or liver cancer
17,000 persons in the United States die with
HCV-related liver disease as documented from
death certificates
by the Hepatitis A virus (HAV)
20%30% of newly infected persons

develop symptoms of acute disease
Note: Symptoms appear in 5%15% of newly

infected adults who are immunosuppressed
Continued on next page
HEPATITIS A
HEPATITIS B
HEPATITIS C
Serologic Tests
for Acute
Infection
IgM anti-HAV
HBsAg in acute and chronic infection

IgM anti-HBc is positive in acute infection only
No serologic marker for acute infection
Serologic Tests
for Chronic
Infection
Not applicableno chronic

infection
HBsAg (and additional markers as needed)
Screening assay (EIA or CIA) for anti-HCV

Verification by an additional, more specific
assay (e.g., nucleic acid testing (NAT) for
HCV RNA)
Screening
Not applicableno chronic
Recommendations
infection
for Chronic
Note: Screening for past acute
Infection
infection is generally not
recommended
Testing is recommended for:

All pregnant women
Persons born in regions with intermediate or high
rates of Hepatitis B (HBsAg prevalence of 2%)
U.S.born persons not vaccinated as infants whose
parents were born in regions with high rates of
Hepatitis B (HBsAg prevalence of 8%)
Infants born to HBsAg-positive mothers
Household, needle-sharing, or sex contacts of
HBsAg-positive persons
Patients with elevated liver enzymes (ALT/AST) of
unknown etiology
Hemodialysis patients
Persons needing immunosuppressive or cytotoxic therapy
Donors of blood, plasma, organs, tissues, or semen
Testing is recommended for:

Persons born from 19451965
Persons who currently inject drugs or who
have injected drugs in the past, even if once
or many years ago
Recipients of clotting factor concentrates
before 1987
Recipients of blood transfusions or donated
organs before July 1992
Long-term hemodialysis patients
Persons with known exposures to HCV (e.g.,
healthcare workers after needlesticks,
recipients of blood or organs from a donor
who later tested positive for HCV)
Children born to infected mothers (do not
test before age 18 mos.)
Patients with signs or symptoms of liver
disease (e.g., abnormal liver enzyme tests)
Donors of blood, plasma, organs, tissues,
or semen
Treatment
Acute: No medication available; best addressed

through supportive treatment
Chronic: Regular monitoring for signs of liver
disease progression; some patients are treated
with antiviral drugs
Acute: Antivirals and supportive treatment

Chronic: Regular monitoring for signs of
liver disease progression; new direct acting
antiviral medications offer shorter durations
of treatment and increased effectiveness,
including higher rates of sustained virologic
response (SVR) which is a marker for cure
Vaccination
Hepatitis A vaccine is
Recommendations recommended for:
All children at age 1 year
Travelers to regions with
intermediate or high rates of
Hepatitis A
Users of certain illegal drugs
(injection and non-injection)
Persons with clotting-factor
disorders
Persons who work with HAVinfected primates or with HAV
in a research laboratory
Persons with chronic liver
disease, including HBV- and
HCV-infected persons with
chronic liver disease
Family and care givers of recent
adoptees from countries where
Hepatitis A is common
Anyone else seeking long-term
protection
Hepatitis B vaccine is recommended for:

All infants at birth
Older children who have not previously been vaccinated
Susceptible sex partners of infected persons
Persons with multiple sex partners
Persons seeking evaluation or treatment for an STD
Susceptible household contacts of infected persons
Healthcare and public safety workers exposed to
blood on the job
Persons with chronic liver disease, including
HCV-infected persons with chronic liver disease
Persons with HIV infection
Persons with end-stage renal disease, including
predialysis, hemodialysis, peritoneal dialysis, and
home dialysis patients
Residents and staff of facilities for developmentally
disabled persons
Travelers to regions with intermediate or high rates
of Hepatitis B (HBsAg prevalence of 2%)
Unvaccinated adults with diabetes mellitus 1959 (for
those aged 60 years, at the discretion of clinician)
Anyone else seeking long-term protection
There is no Hepatitis C vaccine.
Vaccination
Schedule
Infants and children: 3 to 4 doses given over a

6- to 18-month period depending on vaccine type
and schedule
Adults: 3 doses given over a 6-month period (most
common schedule)
No vaccine available
Updated 2014
No medication available

Best addressed through
supportive treatment
2 doses given 6 months apart
www.cdc.gov/hepatitis

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The ABCs of Hepatitis

HEPATITIS B is caused by the Hepatitis B

HEPATITIS C is caused by the

Estimated 3,000 new infections

Estimated 19,000 new infections in 2012

Estimated 22,000 new infections in 2012

Ingestion of fecal matter, even in

Contact with infectious blood, semen, and other body

Contact with blood of an infected person

Travelers to regions with

Infants born to infected mothers

Current or former injection drug users

15 to 50 days (average: 28 days)

45 to 160 days (average: 120 days)

14 to 180 days (average: 45 days)

< 1% of infants < 1 year develop symptoms

Among unimmunized persons, chronic infection

75%85% of newly infected persons

Most persons with acute disease

Acute illness is uncommon. Those who do

by the Hepatitis A virus (HAV)

20%30% of newly infected persons

Note: Symptoms appear in 5%15% of newly

Continued on next page

HBsAg in acute and chronic infection

No serologic marker for acute infection

Not applicableno chronic

HBsAg (and additional markers as needed)

Screening assay (EIA or CIA) for anti-HCV

Testing is recommended for:

Testing is recommended for:

Acute: No medication available; best addressed

Acute: Antivirals and supportive treatment

Hepatitis B vaccine is recommended for:

There is no Hepatitis C vaccine.

Infants and children: 3 to 4 doses given over a

No medication available

2 doses given 6 months apart

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Estimated 3,000 new infections

Estimated 19,000 new infections in 2012

Estimated 22,000 new infections in 2012

Travelers to regions with

Infants born to infected mothers

Current or former injection drug users

< 1% of infants < 1 year develop symptoms

Among unimmunized persons, chronic infection

75%85% of newly infected persons

Acute illness is uncommon. Those who do

20%30% of newly infected persons

HBsAg in acute and chronic infection

No serologic marker for acute infection

Not applicableno chronic

HBsAg (and additional markers as needed)

Screening assay (EIA or CIA) for anti-HCV

Acute: No medication available; best addressed

Acute: Antivirals and supportive treatment

Infants and children: 3 to 4 doses given over a

No medication available