Key points
- Many people with a viral hepatitis infection do not have symptoms and are unaware of their infection.
- Chronic hepatitis B and chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
- Hepatitis A and hepatitis B are vaccine-preventable, and hepatitis C can be cured with treatment.
Overview of Viral Hepatitis in the US
Each year, tens of thousands of people acquire a viral hepatitis infection in the United States. It is a serious public health threat that kills thousands of Americans annually and is a leading cause of liver cancer. Hepatitis A and hepatitis B are vaccine-preventable, hepatitis B can be treated, and hepatitis C can be cured.
The US has the opportunity and the responsibility to eliminate viral hepatitis as a public health threat. By working with clinicians and their patients, we can collectively achieve this goal. See below for further information on the cause, incidence, and prevalence of the most common types of viral hepatitis in the US.
Types and strains
Viral hepatitis is most commonly caused by three viruses: hepatitis A, hepatitis B, and hepatitis C.
- Hepatitis A is caused by the hepatitis A virus (HAV).
- Hepatitis A does not progress to chronic infection.
- There were an estimated 3,300 acute infections in 2023.
- Most people with acute disease recover with no lasting liver damage.
- Death is uncommon but occurs more often among older people and/or those with underlying liver disease.
Visit our clinical overview of hepatitis A for detailed information on HAV.
- Hepatitis B is caused by the hepatitis B virus (HBV).
- Hepatitis B can be a short-term illness for some people, but can develop into a long-term, chronic infection for others.
- There were an estimated 14,400 acute infections in 2023.
- Most people with acute disease recover with no lasting liver damage, and acute illness is rarely fatal.
- There were an estimated 640,000 adults with chronic HBV infection during January 2017–March 2020.1
- 15%–25% of people with chronic infection develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.
Visit our clinical overview of hepatitis B for detailed information on HBV.
- Hepatitis C is caused by the hepatitis C virus (HCV).
- Chronic HCV infection develops in most people.
- There were an estimated 69,000 acute infections in 2023.
- There were an estimated 2.4 million people - and as many as 4 million people - with HCV infection from 2017–2020.2
- Visit our clinical overview of hepatitis C for detailed information on HCV.
Incubation period
Many people with viral hepatitis do not have symptoms and are unaware of their infection. If symptoms occur with an acute infection, they can appear anytime from 2 weeks to 6 months after exposure. Symptoms of chronic viral hepatitis can take decades to develop and are typically the same as those for acute infection.
How it spreads
The different strains of viral hepatitis are transmitted through several possible exposures:
- Hepatitis A is transmitted via fecal-oral route through ingestion of contaminated food or water or close person-to-person or sexual contact with a person who has HAV infection.
- Hepatitis B is transmitted via percutaneous, mucosal, or nonintact skin exposure to infectious blood or other body fluids.
- Hepatitis C is transmitted via direct percutaneous exposure to infectious blood and mucous membrane exposures to blood (though the latter route is less common).
Clinical features
Symptoms of all types of viral hepatitis are similar and can include one or more of the following:
- Abdominal pain, nausea, and/or vomiting
- Dark urine or clay-colored stools
- Diarrhea (HAV only)
- Fatigue
- Fever
- Jaundice
- Joint pain
- Loss of appetite
Learn more about signs and symptoms of HAV infection, HBV infection, and HCV infection.
Prevention
Hepatitis A and hepatitis B are vaccine-preventable. If you suspect a person has been exposed, testing and treatment can prevent complications and interrupt further transmission.
There is currently no vaccine available for hepatitis C. Learn more on how to prevent and control the spread of HCV.
Testing, screening, and diagnosis
Testing is the only way to diagnose a viral hepatitis infection.
- For hepatitis A, test for immunoglobulin M (IgM) anti-HAV.
- For hepatitis B, test for hepatitis B surface antigen (HBsAg) plus IgM antibody to hepatitis B core antigen (anti-HBc).
- For hepatitis C, there is no serologic marker for acute infection.
- Hepatitis A does not progress to chronic infection.
- When screening for the first time, tests for chronic hepatitis B infection should include the triple panel test.
- Testing for chronic hepatitis C should include an HCV antibody test with reflex to nucleic acid test (NAT) for HVC RNA if the antibody test is positive/reactive.
Learn more about hepatitis A, hepatitis B, and hepatitis C clinical testing guidelines.
Treatment and recovery
Treatment for viral hepatitis varies by the type and severity of each infection.
- HAV infection is best addressed through supportive care like rest, fluids, a well-balanced diet, and plenty of fluids to relieve symptoms.
- Acute HBV infection is best addressed through supportive care like rest, a well-balanced diet, and plenty of fluids to relieve symptoms.
- Chronic HBV infection should be monitored for signs of liver disease progression and treated with antiviral drugs.
- Acute and chronic HCV infection should be treated without a waiting period.
- Learn more about clinical care and treatment of HAV, HBV, and HCV.
- Bixler D, Barker L, Lewis K, Peretz L, Teshale E. Prevalence and awareness of Hepatitis B virus infection in the United States: January 2017 - March 2020. Hepatol Commun. 2023 Mar 30.
- Hall EW, Bradley H, Barker LK, Lewis K, Shealey J, Valverde E, Sullivan P, Gupta N, Hofmeister MG. Estimating hepatitis C prevalence in the United States, 2017-2020. Hepatology. 2024 May 13.