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Hepatitis

What is hepatitis?

  • Hepatitis is inflammation of the liver, which causes liver damage, affecting vital functions. Hepatitis is often caused by hepatitis viruses (viral hepatitis); the most common in the U.S. are hepatitis A, B, and C. People can also get hepatitis from excess fat in the liver (MASLD; MASH; steatotic liver disease (SLD)), heavy alcohol use, drug use disorder, toxins, other viral infections (Epstein-Barr virus (EBV); cytomegalovirus (CMV)), some medications, and some medical conditions, such as diabetes, obesity, metabolic disorders, ischemia, and autoimmune disorders.Many people living with hepatitis are asymptomatic or don’t know they are infected. Symptoms for acute hepatitis include light fever, fatigue, appetite loss, nausea, vomiting, belly pain, dark urine, light-colored/grey stools, muscle and joint pain, itchy skin, jaundice (yellow eyes/skin), and feeling unwell. Symptoms for chronic viral hepatitis can take anywhere from 2 weeks to 6 months, to even decades to develop.
  • Viral hepatitis is a serious, life-threatening public health crisis in the U.S. Testing is the first step to receiving life-saving treatment.  All adults should be tested for hepatitis B and hepatitis C.
  • There are five main strains of hepatitis: A, B, C, D, and E. Hepatitis B and C have the greatest impact on public health, affecting millions worldwide and in the U.S.
  • There are many other strains and sub-types of hepatitis. Among them are: hepatitis F (HFV); hepatitis G (HGV; GB virus; GBV-C); hepatitis TT viruses (transfusion transmitted virus (TTV), also known as Torque Teno virus) and hepatitis TT-like viruses); hepatitis SEN (SEN-V; two SEN-V variants (SENV-D and SENV-H)); non-A-E hepatitis (non-A to E hepatitis; sometimes referred to as hepatitis X; non-A-G hepatitis); autoimmune hepatitis (types I and II); neonatal hepatitis.
  • What is the difference between hepatitis A, B, C, D, and E? What is Hepatitis F, G, TT, SEN, and Non-A-G viruses?
    • Hepatitis A, hepatitis B, and hepatitis C are caused by three different viruses that cause liver damage. Each can produce similar symptoms, but they are spread in different ways and can affect the liver differently.
      • Hepatitis A is usually a short-term infection.
      • Hepatitis B and hepatitis C can begin as short-term, but in some people, the virus stays in the body, causing chronic infection and long-term problems with the liver.
      • There are vaccines to prevent hepatitis A and hepatitis B, but no vaccine for hepatitis C.
      • Hepatitis D (caused by HDV virus) and E (caused by HEV virus) are not common in the U.S. but do occur.
      • Hepatitis F is a hypothetical virus being researched, possibly linked to viral hepatitis.
      • Hepatitis G is a newly discovered form of liver inflammation caused by hepatitis G virus (HGV), believed to be a distant relative of the hepatitis C virus.
      • Hepatitis TT (Transfusion Transmitted Virus (TTV), also known as Torque Teno Virus) is a type of virus that passed through transfusions, possibly linked to liver damage, and currently under study.
      • Hepatitis SEN is another newly identified virus currently being studied.
      • Non-A-G/Non-A-E hepatitis consists of all of the hepatitis viruses awaiting identification.
      • Autoimmune hepatitis is when your body's infection-fighting system (immune system) attacks your liver cells.
      • Neonatal hepatitis is liver inflammation occurring only in early infancy, usually between one and two months after birth.

How does hepatitis spread? Is it contagious?

  • Viral hepatitis is contagious. Viruses are all contagious and the most common cause of hepatitis worldwide. Other types of hepatitis (non-viral) are not contagious. The five main hepatitis viruses – A, B, C, D and E—spread in different ways:
    • Hepatitis A and E spread through contaminated food and water.
    • Hepatitis B, C, and D can spread through contact with blood from an infected person. This happens when needles are shared during intravenous drug use.
    • Hepatitis B and D can also spread through other bodily fluids from sexual contact and from parent to child during childbirth.
  • Many people with hepatitis in the United States do not know that they have hepatitis. One in two people with hep B and one in three people with hep C are unaware they are infected. Untreated, hep B and C can cause liver cancer and death. Infected people can also unknowingly transmit it to others.
  • The World Health Organization (WHO) states that, worldwide, most people with viral hepatitis don’t know they have it.
  • The elimination of hepatitis is a national priority. In 2020, the Centers for Disease Control and Prevention (CDC) released universal hepatitis screening recommendations for adults.
  • May 15 is Hispanic Hepatitis Awareness Day.
  • World Hepatitis Day is observed on July 28.

Hepatitis A (HAV; Hep A)

  • Hepatitis A (HAV; Hep A) is a highly contagious, usually short-term, liver infection that can be spread person-to-person and through tainted food or drink. It can be found through testing and is preventable by vaccine.
  • At risk for hepatitis A: People exposed to poor sanitation; people who use drugs (injection or non-injection; illegal drugs); people experiencing homelessness; men who have sex with men (MSM); incarcerated people; certain healthcare and lab workers; people with chronic liver disease; people who are HIV positive; international travelers; people in close contact with international adoptees; people who live with someone who has hep A.
  • Persons aged 30–39 years had the highest rate of hepatitis A.
  • In the US during 2022, there were 2,265 new cases and 4,500 estimated infections of hepatitis A reported, as well as 118 hepatitis A-related deaths.
  • Since 2016, there have been multiple hepatitis A outbreaks in 37 states across the US, caused primarily by person-to-person spread among adults using drugs and experiencing homelessness. After annual increases from 2015, cases began to decrease in 2020.
  • There was a 60% decrease of newly reported cases of hepatitis A from 2021–2022, but the number of 2022 cases remained 1.6 times higher than 2015.
  • In 2022 58% of hepatitis A cases were among non-Hispanic White persons.

Hepatitis B (HBV; Hep B)

  • Hepatitis B (HBV; Hep B) is the most common serious liver infection and blood borne infection in the world. Hepatitis B is a type of liver infection caused by the hepatitis B virus (HBV); it can be short-term (acute) but can progress to a long-term or life-long illness (chronic), including liver disease/liver cancer. Hepatitis B is spread with blood, semen, or other body fluids, or can be passed through birth. It is preventable with vaccines. Testing is the only way to know if you are infected. Treatment can control hepatitis B in infected people.
  • Untreated long-term (chronic) hepatitis B and hepatitis C can cause cirrhosis, liver cancer (hepatocellular carcinoma (HCC)) and death.
  • Around the world, two billion people (one in three) are estimated to have been infected with the hepatitis B virus.
  • The World Health Organization (WHO) has estimated that in 2022, 254 million people were living with chronichepatitis B. The WHO also estimated that hepatitis B resulted in 1.1 million deaths that same year, and that there were 1.2 million new hepatitis B infections each year.
  • Hepatitis B disproportionately affects children. The hep B virus can be passed on through the mother. However, hepatitis B can be prevented with a vaccine given soon after birth with boosters a few weeks later, offering nearly 100% protection against the virus.
  • According to the Centers for Disease Control and Prevention (CDC), during 2022:
    • 2,126 new cases of acute hepatitis B.
    • 13,800 estimated acute HBV infections.
    • 16,729 cases of newly reported chronic hepatitis B.
    • 1,797 hepatitis B-related deaths.
  • An estimated 660,000 adults are living with hepatitis B in the U.S.
  • Estimates of the number of adults living with hepatitis B infection in the U.S. range from 660,000 (CDC) to 2.4 million (chronic; Hepatitis B Foundation).
  • At risk for hepatitis B: Anyone can get hepatitis B, but high-risk people include: people who inject drugs or share needles, syringes, drug equipment (the most common risk factor for acute HBV infection, because of the opioid crisis); infants of infected mothers; sex partners of infected people (esp. men who have sex with men); people exposed to blood, body fluids, or sores of someone who has hepatitis B (such as lab workers); people who have gotten tattoos with infected needles; anyone sharing contaminated items with someone who has hepatitis B infected person (toothbrushes, razors, or medical equipment (eg,  glucose monitors)); people with certain medical conditions (e.g., HIV, chemotherapy, dialysis); people who live in households with some who has hepatitis B; people born in certain regions of the world with a high prevalence of hepatitis B; and rarely, dialysis/transplant patients and healthcare and public-safety workers exposed to blood or who work in facilities with inadequate infection control.
  • Hepatitis B symptoms include abdominal pain; dark urine; fever; joint pain; appetite loss; nausea/vomiting; fatigue/weakness; jaundice (yellowing skin and whites of eyes); light or clay-colored stool; fluid swelling in belly or arms and legs. Not all people newly infected with HBV have symptoms.
  • “Chronic” and “acute” hepatitis B: HBV can be limited or life-long. When a person is first infected (sometimes for only a few weeks, with mild or no symptoms) it is called an "acute infection" (or a new infection or short-term). When the infection lasts more than six months, it is called a long-term or "chronic infection" (which can have no symptoms for decades, or immediate symptoms). A simple blood test can tell the difference.
  • 1 out of 2 people with hepatitis B are unaware.
  • A person can spread the hepatitis B virus and not know it.
  • HBV is highly transmissible and infectious on surfaces for at least 7 days.
  • Approximately 50% of people living with chronic hepatitis B don’t know they have it and can unknowingly transmit their infection to others.
  • Approximately 50-70% of people with acute hepatitis B are not symptomatic.
  • Acute hepatitis B symptoms usually appear about 1 to 4 months after infection but can appear as early as two weeks.
  • People who inject drugs have the highest rates of new (incident) hepatitis B and hepatitis C infections.
  • The acute hepatitis B rate remained stable during 2021-2022.
  • 52% of all acute hepatitis B cases were aged 40–59 years.
  • 89% of new (incident) chronic hepatitis B cases were in people 30 years and older.
  • While the rate of acute hepatitis B was lowest among non-Hispanic A/PI (Asian/Pacific Islander) persons, the rate of new (incident) chronic hepatitis B was highest in this group. The rate of new (incident) chronic hepatitis B cases among non-Hispanic A/PI persons was 11.2 times as high as the rate among non-Hispanic White persons.
  • Highest rates of chronic hepatitis B infection in the US are among foreign-born individuals, especially people born in Asia, the Pacific Islands, and Africa. Foreign-born individuals account for 14% of the general population, but 69-70% of those with chronic HBV infection.
  • Hepatitis B and the ensuing liver cancer are among the largest health disparity issues for these groups of foreign-born people in the US.
  • A 2018 demographic breakdown of foreign-born people in the U.S. with chronic hepatitis B: about 59% had emigrated from Asia, 19% from the Americas, and 15% from Africa.
  • The rate of acute hepatitis B is highest in non-Hispanic Black populations, increasing 11.1% during 2021–2022, and was 1.7 times as high as the rate among non-Hispanic White persons.
  • Asian/Pacific Islander (A/PI) populations have the highest rates of hepatitis B-related deaths.
  • Hepatitis B-related deaths among non-Hispanic A/PI persons and non-Hispanic Black persons were 8.5 times and 2.6 times higher than among non-Hispanic White persons, respectively.
  • About 2% of people with HIV are coinfected with HBV and are at greater risk for complications and death from HBV infection.
  • Hepatitis B disproportionately affects children. Only 5% of adults who are infected by hep B develop a chronic infection, but 30% (1 in 3) of children under age 6 do.
  • The younger a person’s age when they are infected with Hep B, the greater the chance of the infection becoming chronic and lifelong, the risk goes down as a child gets older. The majority of children 6 and older infected with the hepatitis B virus recover completely.
  • Approximately 9 in 10 infants infected with hepatitis B will develop life-long, chronic infection.
  • A one-time universal screening for hepatitis B could save 23,000 lives and nearly $600 million in the U.S., according to a study in the journal Clinical Infectious Diseases.
  • 70% of adults in the US reported they were unvaccinated for HBV (2018).
  • 464,000 children’s lives have been saved by hepatitis B vaccines since 1974. Every 10 seconds, one child’s life is saved from a fatal disease by a vaccine.

Hepatitis C (HCV; Hep C)

  • Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) and is spread through contact with blood from an infected person. HCV is one of the most common types of viral hepatitis in the US. It is transmitted through blood. Most people become infected by sharing needles or other equipment used to prepare and inject drugs. For some, hepatitis C is a short-term illness, but for more than half (80%) it becomes a long-term, chronic infection.
  • Untreated, chronic hepatitis B and C can result in cirrhosis, liver cancer, and death.
  • There is no HCV vaccine, but treatments, called direct acting antivirals (DAAs) can cure most persons with it (95%). Treatment is always needed for chronic hepatitis C.
  • Acute vs. chronic HCV: People having HCV for a few weeks to a few months have “acute” hepatitis C. When people have hep C longer than 6 months, it becomes “chronic” hepatitis C, which can last for years and lead to serious liver damage.
  • More than 2 million adults in the US are estimated to have hepatitis C.
  • 1 out of 3 people with hepatitis C are unaware.
  • Estimates of the number of people with HCV can vary because the National Health and Nutrition Examination Survey (NHANES), the main source of public health data in the US, does not sample certain populations, such as people who are incarcerated, homeless individuals, nursing home residents, persons on active military duty, and immigrants.
  • Globally, an estimated 50 million people have chronic hepatitis C virus infection, with about 1.0 million new infections occurring per year.
  • In 2022, approximately 242 000 people died from hepatitis C worldwide, mostly from cirrhosis and hepatocellular carcinoma (liver cancer), according to the WHO.
  • HCV is the outstanding cause of non-A, non-B hepatitis.
  • People with HCV who are unaware of their infection status can unknowingly transmit the virus to others.
  • The hepatitis C virus is usually spread when someone comes into contact with blood from an infected person.
  • At risk for HCV:
    • Anyone who has ever injected, snorted or inhaled an illegal drug, especially those who shared drug injection/preparation equipment; people with unusual liver test results in which the cause wasn't found (including alanine aminotransferase (ALT) blood tests); children of mothers with HCV; healthcare, emergency medical, and public safety personnel exposed to HCV infected blood/needles or improper safety procedures; pregnant people, during the pregnancy; maintenance hemodialysis patients; people with hemophilia who received clotting factor before 1987; people who received transplants or blood transfusions before 1992; sexually active people; sexual partners of anyone with hepatitis C; men who have sex with men (MSM); people with HIV; anyone who has been in prison; people receiving piercings or tattoos in unclean environments or using unsterile equipment; people sharing glucose monitors, razors, nail clippers, toothbrushes, other items; and others.
  • HCV is not spread through food, water, or mosquitoes.
  • HCV is of particular concern for people with kidney disease. There is a much higher prevalence of HCV in people with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) than in the general population. HCV can also cause kidney disease.
  • HCV is best prevented by avoiding behaviors that spread the virus.
  • IV drug users have the highest rates of new hepatitis B and hepatitis C infections.
  • HCV/HIV coinfection: HCV/HIV coinfection means that a person has both viruses at the same time. For every 100 people with HIV, approximately 21 of them also have HCV.
  • Approximately 5% of infants born to infected mothers will get hepatitis C (neonatal hepatitis C).
  • Acute HCV symptoms usually happen 2–12 weeks after exposure. Chronic hepatitis C usually has no symptoms for many years, and they appear only after the virus damages the liver enough to cause them. HCV symptoms include: chronic fatigue and depression; bleeding or bruising easily; loss of appetite; nausea and vomiting; stomach pain; fever; yellow skin and eyes (jaundice); dark urine; light colored stool; itchy skin; joint pain; fluid buildup in the abdomen (ascites); swelling in legs; weight loss; confusion, drowsiness and slurred speech (hepatic encephalopathy); spiderlike blood vessels on skin (spider angiomas).
  • There were 93,805 newly reported cases of chronic HCV during 2022.
  • There were 67,400 estimated acute HCV infections during 2022, of which 4,848 cases were new.
  • Chronic HCV infections are highest among two age groups: 25–45 and 55–70 years.
  • Persons aged 30–39 years had the highest rates of acute HCV.
  • Between 2013 and 2020, the number of acute HCV infections more than doubled.
  • Then in 2022, the estimated number of new HCV infections declined for the first time after more than a decade of consecutive annual increases but remained high at 67,400 cases.
  • However, in 2022, the number of acute hepatitis C cases was still 2 times as high as 2015.
  • 65% of new chronic HCV cases occurred among men (2022).
  • The rate of new chronic HCV cases was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (2022).
  • Acute HCV was highest among males, people 30–39 years old, non-Hispanic AI/AN persons, and those in Eastern and Southeastern states (2022).
  • Rate of acute HCV is highest in non-Hispanic American Indian/Alaska Native (AI/AN) populations.
  • The rate of acute HCV in non-Hispanic White persons decreased but increased among non-Hispanic AI/AN persons 7.4% and was 1.9 times higher (2021–2022).
  • There were 12,717 hepatitis C-related deaths in 2022.
  • In 2022, the death rate for HCV decreased (2022: 2.89 deaths per 100,000) (-9% from 2021: 3.18 deaths per 100,000) (-22% from 2018: 3.72 deaths per 100,000 population).
  • HCV-related deaths are highest in non-Hispanic AI/AN and non-Hispanic Black persons.
  • HCV-related deaths were 3.3 times higher in non-Hispanic AI/AN people and 1.7 times higher in non-Hispanic Black persons than non-Hispanic White persons.

HBV & HCV/HIV Coinfection

  • People with HIV and liver disease are at risk for severe hepatitis A virus (HAV) infection.
  • People with HIV with hepatitis B virus (HBV) or hepatitis C virus (HCV) are at increased risk for morbidity and mortality.
  • HBV or HCV can affect the management of HIV in patients.
  • HIV positive people should be vaccinated against hepatitis A and hepatitis B.
  • HIV positive people should be tested for hepatitis B and hepatitis C.
  • HCV/HIV coinfection means that a person has both viruses at the same time. For every 100 people with HIV, approximately 21 of them also have HCV.

Hepatitis D (HDV; Hep D; “delta hepatitis”)

  • Hepatitis D (HDV) is one of the five known hepatitis viruses. It was discovered in 1977 in patients with chronic hepatitis B (HBV).
  • Globally, hepatitis D (HDV) is most common in Eastern Europe, Southern Europe, the Mediterranean region, the Middle East, West and Central Africa, East Asia, and the Amazon Basin in South America. HDV is uncommon in the United States; most cases occur among people who migrate or travel to the U.S. The number of HDV cases in the U.S. is unknown.
  • HDV is known as a “satellite virus,” because it can only infect people with hepatitis B (HBV; “coinfection”). The illness can be short or long-term, coming in acute and chronic forms.
  • People who have chronic hepatitis B and D develop complications more often and more quickly than people who have chronic hepatitis B alone.
  • There is no vaccine for HDV; the hepatitis B vaccine can protect people from HDV infection, but treatment success is low.
  • Globally, it is estimated that HDV affects nearly 5% of people who have chronic hepatitis B (HBV).
  • HDV has similar risk factors/groups and symptoms to hepatitis A, B, and C. Symptoms usually appear 3–7 weeks after first infection.
  • HDV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing. HDV spreads the same way that hepatitis B spreads, through contact with an infected person’s blood or other body fluids.
  • HDV can only infect people who are also infected by the hepatitis B virus (HBV); infection can occur simultaneously (“coinfection”) or after infection with hep B (“superinfection”). HDV could be called a disease amplifier. It causes HBV to progress more rapidly, causing cirrhosis and liver failure, making it more deadly.

Hepatitis E (HEV)

  • Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). HEV is found in the stool of HEV infected people. It is uncommon in the U.S. and developed countries. It is most common in developing countries with inadequate water supply and poor environmental sanitation; people often get HEV from drinking contaminated water. People living in crowded camps or temporary housing, esp. refugees and displaced people, are at high risk. Symptoms of HEV are similar to other forms of hepatitis; however, many people, especially young children, can have no symptoms. Most people with healthy immune systems fully recover. There is no vaccine for HEV.
  • There are an estimated 20 million HEV infections worldwide every year. 3.3 million of these infections become symptomatic HEV cases.
  • For pregnant women, HEV can be a very serious illness, with a mortality rate of up to 30% in their third trimester. HEV is also a serious health threat to people with preexisting chronic liver disease and organ transplant recipients on immunosuppressive therapy.

A note on F, G, and TT viruses:

  • Over the past decade, several hepatitis viruses have been identified, beyond hep A through E.  Acute hepatitis not caused by hepatitis viruses A to E or alcohol, drugs, or autoimmune disease is important because 29% of these cases result in serious illnesses, such as fulminant hepatic failure, aplastic anemia, and progression to chronic hepatitis and cirrhosis.

Hepatitis F (HFV)

  • Hepatitis F virus (HFV) was identified in 1991. It is a hypothetical, poorly defined, virus of uncertain significance linked to viral hepatitis. Hepatitis F may be a mutant hepatitis C.

Human pegivirus 1 (HPgV-1)

  • Human pegivirus 1 (HPgV-1) was formerly known as “Hepatitis G” (HGV), hep G; GB virus; GB virus type C (GBV-C).
  • HPgV-1 is transmitted by percutaneous injuries (PIs), contaminated blood and/or blood products, through sexual contact, and mother-to-child transmission, similar to HBV and HCV.
  • HPgV-1 is believed to be a distant relative of the HCV virus. In its original classification, HGV, HPgV-1 was first described early in 1996. HPgV-1 is still being studied. What is known is that transfused blood containing HPgV-1 has caused some cases of hepatitis. For this reason, patients who require large amounts of blood or blood products are at risk of HPgV-1.
  • 3-15% of normal individuals have antibodies to HPgV-1.
  • Between one-sixth and 25% of the global population is estimated to be positive for HPgV-1 antibodies.
  • It is estimated that 1% to 4% of blood donors worldwide are carriers of HPgV-1.
  • Often patients with HPgV-1 are infected at the same time by the hepatitis B or C virus, or both. In about 3 of every 1,000 patients with acute viral hepatitis, HPgV-1 is the only virus present. There is some indication that patients with HPgV-1 may continue to carry the virus in their blood for many years and so might be a source of infection in others.
  • Some recent studies indicate that HPgV-1 may actually have a beneficial clinical effect on many diseases, such as acquired immunodeficiency syndrome (AIDS) and HCV.

Hepatitis TT Viruses (transfusion transmitted virus (TTV), Torque Teno Virus), and Hepatitis TT-like Viruses

  • Hepatitis TT (transfusion transmitted) viruses were recently discovered in the late 20th century. Some studies indicate that they are passed on by blood transfusion.
  • TTV is widespread, reaching 95% of healthy people in some regions of the world.
  • Studies indicate it can be spread in several ways: fecal-oral, parenteral, and sexual.
  • Some studies have associated TTV with different liver diseases, such as post-transfusion hepatitis, hepatitis B, and hepatitis C, but this is still under study.
  • Another study states that TTV appears to correlate with some acute and chronic hepatitis cases and may produce liver damage under specific circumstances.
  • However, the association between TTV and liver disease is disputed by some scientists.

Hepatitis SEN (SEN-V; two SEN-V variants (SENV-D and SENV-H))

  • SEN virus (SENV) is named after the initials of the patient with HIV from which it was first isolated.
  • Recent studies negated the link between SEN and post-transfusion hepatitis. Further studies may reveal more about its effects.
  • SEN’s prevalence varies by geographic region.  One sample detected SEN in as many as 30 percent of patients who received transfusions and 3 percent of patients who did not receive transfusions.
  • It appears to be transmitted by transfusion. One sample detected SEN in as many as 30 percent of patients who received transfusions, and 3 percent of patients who did not receive transfusions.

Non-A-E Hepatitis (Non-A to E Hepatitis; “acute non HepA-E hepatitis”; sometimes referred to as Hepatitis X; Non-A-G hepatitis)

  • “Non hepa A-E” of unknown origin is severe hepatitis not caused by the five strains of the virus (A-E).
  • The cause of non-A-E hepatitis is not currently known.
  • Non-A-G/Non-A-E hepatitis consists of all of the hepatitis viruses awaiting identification.
  • Non-A-E hepatitis is a “diagnosis of exclusion,” made through process of elimination, when all other potential causes have been eliminated, and the diagnosis is based on the absence of any other identifiable condition.
  • Non-A-E hepatitis is similar to the other forms of acute hepatitis. In most cases, no source of exposure can be identified; some rare cases have been reported after blood transfusions.  Non–A-E’s lack of the regular risk factors for hepatitis suggests that some cases may be due to nonviral causes, such as an autoimmune process, environmental exposure, or drugs.
  • There is no treatment or preventative measures for non-A-E hepatitis.
  • Acute non-A-E-hepatitis in children is rare but severe, often resulting in acute liver failure.

Autoimmune Hepatitis (types I and II)

  • Autoimmune hepatitis is when the body's immune system attacks liver cells. It is a long-term chronic liver disease, causing inflammation and damage.
  • Causes are unknown and it is more likely in people with other autoimmune conditions.
  • Other viruses that can cause acute hepatitis:
    • Epstein-Barr virus (EBV)
    • cytomegalovirus (CMV)
    • parvovirus
    • enteroviruses
    • adenoviruses (adenovirus type 41 (children)
    • rubella virus
    • herpes viruses (HHV-1, HHV-2, HHV-6, HH-7)
    • human immunodeficiency virus (HIV)
  • Other infectious agents that may cause hepatitis:
    • Brucella spp
    • Coxiella burnetiid
    • Leptospira
  • Neonatal Hepatitis (neonatal hepatitis B/C/cytomegalovirus and others, neonatal HBV, congenital hepatitis)
  • Neonatal hepatitis is liver inflammation occurring only in early infancy (one and two months after birth).
  • Approximately 20% of infants with neonatal hepatitis were infected by a virus from their mother before birth or shortly after birth. These viruses include cytomegalovirus, rubella (measles) and hepatitis A, B or C viruses. In the other 80%, no specific virus can be identified as the cause, but many experts suspect a virus.
  • Early diagnosis is critical.
  • There is no cure for neonatal hepatitis, but there are treatments.

Epstein-Barr virus (EBV)

  • Epstein-Barr virus causes acute viral hepatitis, but most patients recover.

Cytomegalovirus (CMV; human cytomegalovirus (HCMV))

  • Cytomegalovirus (CMV) infection can cause acute viral hepatitis in immunocompromised individuals, particularly liver transplant patients.
  • Human cytomegalovirus (HCMV) affects 40% to 100% of the world population. It is transmitted through close contact by body fluids (saliva, blood, urine, breast milk, semen and cervical secretions), and by organ transplantation. Most people with healthy immune systems are asymptomatic, but immuno-compromised people may experience severe complications.
  • There are no specific guidelines for treatment, but the majority of patients recover on their own.

Toxic Hepatitis

  • Toxic hepatitis causes include:
    • Industrial chemicals, including vinyl chloride, carbon tetrachloride and certain pesticides and herbicides.
    • Over the counter (OTC) medications, especially high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol®).
    • Prescription drugs, including statins, certain antibiotics and anti-seizure medications.
    • Non-prescribed drugs such as ecstasy, cocaine or off-label use of anabolic steroids.
    • Some herbs and supplements in large or frequent doses.
  • Prevention:
    • Toxic hepatitis can't always be prevented. But you may reduce your risk if you:
      • Limit medications; look into nondrug options for common medical problems.
      • Take medications only as directed; don’t take too much.
      • Before taking herbs and supplements talk to your doctor.
      • Alcohol and drugs don’t mix.
      • Take precautions with chemicals.
      • Keep medicines and all chemicals away from children.
  • Look up medications and supplements linked to liver damage at The National Institutes of Health LiverTox website.

Alcohol-Induced Hepatitis

  • Alcohol-induced hepatitis can be chronic or acute. You can get acute hepatitis after a short drinking binge or chronic hepatitis from chronic, heavy alcohol use (alcohol use disorder/AUD).

Met+ALD (metabolic with alcohol-associated liver disease)

  • There is a new category for people with alcohol-associated liver disease (ALD) and MASLD, called Met+ALD (metabolic with alcohol-associated liver disease).

Steatotic Liver Disease (SLD)

  • Steatohepatitis/steatotic liver disease (SLD) means hepatitis from fat. Information about the following conditions causing hepatitis can be accessed on the ALF site:
    • Steatotic liver disease (SLD)Metabolic dysfunction-associated steatotic liver disease (MASLD)
    • Metabolic dysfunction-associated steatohepatitis (MASH)

Other Causes of Hepatitis:

  • Cholestasis. Cholestasis means that bile doesn’t flow through the liver’s biliary tract. Then bile backs up into the liver, causing damage and hepatitis. It can happen suddenly (acute), due to an obstruction, or gradually (chronic), from a disease or condition. Pregnancy can also increase the risk for this condition.
  • Inherited metabolic disorders (metabolic-liver-disease). Rare genetic disorders that affect metabolism can also affect the liver: Wilson disease; hemochromatosis; Gaucher disease; glycogen storage disease (GSD); and others.
  • Ischemia (ischemic hepatitis, “shock liver”; ischemic hepatitis, hepatic infarction, and ischemic cholangiopathy). Ischemia is sudden or gradual loss of blood to an organ and can cause serious injury to the liver due to circulatory failure.  It can also cause acute or chronic inflammation.
  • Causes of ischemia include sudden vasoconstriction, occlusions such as blood clots and arterial diseases that narrow arteries. Ischemia can also be a response to shock from a severe infection or organ failure.

Last updated on December 10th, 2025 at 04:31 pm

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