What is infectious hepatitis and how is it transmitted? (Hepatitis A/B/C/D)

What is hepatitis and its infectious form? How is it transmitted and why is it dangerous? And did you know that it is divided into several types and each has its own specifics? Get to know viral hepatitis better.

Jaundice is a symptom that occurs in liver disease. It is technically referred to as icterus, or yellowing of the skin, mucous membranes, tissues, and whites of the eyes. This yellow coloration is most noticeable on the skin and whites of the eyes.

The reason for the occurrence is a malfunction of the liver. As a consequence, the level of yellow dye (bilirubin) in the blood increases unnaturally. It occurs due to various causes. It can be of viral or non-viral origin. In this article we provide information about viral hepatitis.

What is viral hepatitis?

Inflammation of the liver is technically called hepatitis. Hepar is the liver and the suffix itis is the name of the inflammation. We know acute and chronic hepatitis. Chronic hepatitis lasts longer than 6 months. The name hepatitis describes the yellow colour of the skin and other mucous membranes already mentioned.

The term hepatitis was used as early as the 5th century by the Roman physician Caelius Aurelianus.

However, hepatitis can be asymptomatic, meaning that it does not show symptoms. In addition, we know of a form that mimics influenza. Of course, one of the forms it takes is icterus.

Symptoms include:

• fatigue
• general weakness
• lack of appetite
• joint pain
• icterus
• dark urine (described as being as dark as cola)
• pale stools
• stomach upset
• pain in the right side, lower back (pressure)
• tightness in the liver area on shaking
• feeling of fullness, even after eating
• constipation, but also diarrhoea
• enlargement of the liver
• in liver failure, disturbances of consciousness, coma

Tip: For more on the disease itself, see the article on jaundice.

Hepatitis is divided into several types, as shown in the table below

Hepatitis is dangerous mainly because of the serious complications it causes. These include, for example, pancreatitis, brain damage, inflammation of the heart muscle.

The most serious are cirrhosis, liver cancer, liver failure and death.

How is hepatitis transmitted?

As indicated, we know different types of infectious hepatitis. Each has its own specifics and so does transmission.

Hepatitis A

Infectious hepatitis A is caused by the HAV virus, which is an RNA virus. It has a direct damaging effect on liver cells.

Its spread is via the faecal-oral route. This means that the point of entry for infection is the digestive tract.

This transmission occurs, for example, through contaminated food, soil, water. We also know the term dirty hands disease. Which means that transmission occurs after contact with a contaminated object with the hands. The virus is excreted in the stool.

A strong feature of this virus is that it is excreted in the faeces as early as 2 weeks before the first symptoms appear, and approximately 2 weeks after they have subsided. The incubation period ranges widely, from 15-48 days.

The manifestations of the disease are rather general, such as increased body temperature, muscle pain, weakness, joint pain, nausea, vomiting, lack of appetite. But also diarrhoea and markedly dark urine. And also icterus.

Rarer is parenteral transmission, i.e. outside the digestive tract. On the contrary, it does not spread through the placenta. This means that transmission does not occur from mother to foetus. This virus does not cause chronic infections.

Approximately 1.4 million cases are reported worldwide each year, but the prevalence is expected to be up to 10 times higher.

Specific populations are particularly at risk, such as:

• Healthcare workers and other healthcare workers
• teachers and educators
• social workers
• police officers
• public and long-distance transport drivers
• waste workers

Vaccination can be a prevention measure. But the main prevention methods include increased hygiene and increased health surveillance at the point of outbreak and spread. Hand washing after using the toilet, before preparing food is necessary.

Adequate heat treatment of food or water is also important. Protection of drinking water from contamination is of great importance. There is a risk of infection when travelling, especially to countries in Africa, Asia and South America.

When travelling, it is important to follow the principles of thorough hand hygiene, avoiding the consumption of potentially contaminated and undercooked food. The virus is destroyed by exposure to heat at 85 °C for at least 1 minute.

Unpackaged water, drinks and ice are at risk, as are unwashed and unpeeled fruit.

Hepatitis B transmission

Hepatitis B is caused by the HBV virus, which belongs to the group of DNA viruses. Approximately 5 % of the earth's population carries this virus. Hepatitis B is the most serious virus that a person can acquire.

And as a complication of the disease is cirrhosis, liver failure and death.

It's transmitted through blood and bodily fluids, which means saliva, ejaculate, vaginal fluids, kissing and sexual intercourse. The virus can also be transmitted through the use of contaminated equipment in tattooing, piercing.

But also when using common hygiene items such as toothbrushes and razors. Transmission also occurs from mother to child at birth. If the child becomes infected in this postnatal period, there is a high risk of liver cancer after 20 years of life.

The incubation period of the disease is wide, from about 30 to 180 days. Its symptoms may include fatigue, weakness, nausea, lack of appetite and also skin rashes. But also icterus and light stools.

It is believed that up to 80% of liver cancers are caused by chronic hepatitis B.

Effective protection is vaccination, which takes place in three vaccinations. Consistent sterilization and cleaning of equipment is important, thus ensuring a higher standard of hygiene.

Groups of people who come into contact with people with the disease are at risk, especially health workers and others working in health care facilities. But also in other public sectors where one comes into contact with masses of people. For example, police officers, bank workers and so on.

In the case of tourism, but also outside the travelling hobby, there is a high risk in accidental sexual contact, in the use of non-sterile instruments, for example in dental treatment. But also in transfusion or in the case of drug injection.

In the world, it is endemic mainly in Southeast Asia, the Middle East, sub-Saharan Africa and Latin America, but also in countries in southern and eastern Europe.

How is hepatitis C transmitted?

It is caused by the HCV virus, which is also an RNA virus. It has six types and then a large number of subtypes. Hepatitis C was not known until 1989. At that time, only types A and B were known to mankind.

During this period, liver inflammation following blood transfusions was common. However, none of the viruses known to date caused it. Since 1992, testing of all blood donors has been compulsory.

Transmission is via the blood. Outside the body, the virus dries up quickly and does not survive for long. That is, as already mentioned, until 1992, also via transfusion.

And the main way and reason for the spread of infection is the injection of drugs.

There are believed to be approximately 175 million infected people worldwide, representing up to 3% of the population.

As has already been written, spread is ensured parenterally, i.e. outside ingestion through the digestive tract and the mouth. And this is through blood, through injecting drugs. But also through inadequate hygiene and sterilisation measures in the health sector, for example during dialysis.

In tattooing or piercing.

But also from mother to foetus during childbirth. There is also a risk of transmission during unprotected sexualintercourse. But the blood route must be ensured. For example, in the case of damage to the integrity of mucous membranes and skin. In the case of injuries during unprotected or violent sexual intercourse. For example, during oral intercourse.

The risk is increased during anal intercourse, where the risk of damage to the integrity of the mucous membranes is high.

The disease has an incubation period ranging from 15 to 160 days. It is often asymptomatic, or general flu-like or digestive problems may occur. Icterus is not typical until liver damage occurs years later.

Then cirrhosis or hepatocellular carcinoma is present.

No vaccination is yet effective against this type of hepatitis, i.e. hepatitis C (in 2021). Disinfection and sterilisation of medical instruments, testing of blood donors are important, as is the observance of hygiene rules for tattoos and piercings.

In the case of drug addicts, the specific use of disposable needles is recommended.

Hepatitis D

It is caused by HDV, the RNA virus, and its multiplication is conditional on the presence of hepatitis B. Both viruses can be co-infected, but also as a later subsequent infection during infection with type B.

It is also widespread worldwide, in Europe mainly in countries such as Spain, Italy, Moldova and Romania.

Its transmission is similar to that of hepatitis B virus. It is also spread between people, through contact with contaminated blood and body fluids, sexual contact and drug use.

Infection with this type exacerbates existing hepatitis B. Severe hepatitis sets in, with severe symptoms. Cirrhosis often develops. If hepatitis B and D are infected at the same time, symptoms are milder.

The prevention of this infection is practically based on the prevention of hepatitis B. The rule is that it does not break out without it. Of course, vaccination against hepatitis B is also effective against type D.

Information on hepatitis E

HEV is the cause of hepatitis E. There are 5 genotypes. Genotypes 1 and 2 are human. Transmission is enteric, i.e. ingested through the gastrointestinal tract.

Preferably through contaminated water.

Genotypes 3 and 4 are zoonotic. Animal-to-human transmission is possible, especially in domestic slaughterhouses. From pork, but also from game meat, such as wild boar or deer. The cause is poorly or inadequately cooked meat.

Genotype 5 is found in birds. Transmission to humans has not yet been demonstrated. In addition to the above information, hepatitis E is also known to be transmitted from mother to foetus, intrauterine or during birth.

It is endemic mainly in countries in Asia, Africa and Latin America. The severity is higher in genotypes 1 and 2. Acute hepatitis E is most severe in pregnant women in the third trimester, with a high risk of maternal death (20 %).

The risk of miscarriage or stillbirth or congenital hepatitis E also increases.

Summary of its characteristics:

• it is resistant to the external environment
• infection is via the faecal-oral route
• the course is similar to type A, but there is more pronounced jaundice and liver failure is more common
• does not progress to chronicity
• it is very rare in this country (mainly brought by immigrants)
• no vaccination has been developed

Hepatitis F and its existence

Although its existence is not confirmed, literature can be found mentioning hepatitis F. It is reportedly caused by a virus similar to HBV. Transmission is thought to occur by faecal-oral infection. It does not progress to chronicity.

Hepatitis G

Confirmed in 1996, caused by a virus similar to HCV. It is blood-borne and is caused by a pre-existing infection with hepatitis C. The incubation period is similar to HBV, ranging from 30 to 180 days.

HGV is thought to slow the development of HIV.