Walgreens Specialty Pharmacy > Conditions and therapies > Viral hepatitis
Viral hepatitis
PrintHepatitis is a viral infection that results in inflammation of the liver. Patients afflicted with viral hepatitis may exhibit symptoms of fever, weakness, nausea, vomiting, jaundice, and decreased appetite. Hepatitis A, B, and C are the most common forms of the virus in the United States. Other types of viral hepatitis that are less common include hepatitis D and E. Prompt diagnosis and appropriate treatment with immunoglobulin, interferon therapy, or a vaccination for hepatitis are important for those who have been exposed to the virus.
Select any question to learn more about viral hepatitis below:
Hepatitis A
What is hepatitis A?
What are the statistics for hepatitis A?
Who is at risk for hepatitis A?
How is hepatitis A transmitted?
What are the symptoms of hepatitis A?
How is hepatitis A diagnosed?
What treatment is available for hepatitis A?
Is there a cure for hepatitis A?
How can hepatitis A be prevented?
Can the hepatitis A vaccine be administered to immunocompromised persons, such as those with HIV or AIDS?
Hepatitis B
What is hepatitis B?
What are the statistics for hepatitis B?
Who is at risk for hepatitis B?
How is hepatitis B transmitted?
What are the symptoms of hepatitis B?
How is viral hepatitis B diagnosed?
What are the complications of a hepatitis B infection?
How is hepatitis B treated?
Is there a cure for hepatitis B?
Is hepatitis B preventable?
Can the hepatitis B vaccine be given to immunocompromised persons, such as those with HIV or AIDS?
Are there any special concerns for pregnant women with hepatitis B?
Hepatitis C
What is hepatitis C?
What are the statistics for hepatitis C?
Who is at risk for hepatitis C?
How is hepatitis C transmitted?
What are the symptoms of hepatitis C?
How is hepatitis C diagnosed?
What treatment is available for hepatitis C?
Is there a cure for hepatitis C?
How can hepatitis C be better managed?
How can viral hepatitis C be prevented?
Can a person be reinfected with viral hepatitis?
I think I’ve been infected with hepatitis. What should I do?
How can Walgreens Specialty Pharmacy help?
Where can I find more information on viral hepatitis?
What is hepatitis A?
Hepatitis A, a liver disease caused by the hepatitis A virus, is an acute illness that usually lasts about three weeks. In about 15 percent of cases, it may persist for six to nine months. Although hepatitis A represents the highest percentage of all hepatitis cases, it is not a chronic infection. No long-term effects are associated with hepatitis A. Once you get hepatitis A, you cannot be infected with it again.
What are the statistics for hepatitis A?
Data from the U.S. Centers for Disease Control and Prevention (CDC) indicate that one-third of Americans have evidence of past hepatitis A infection. In 2003, approximately 60,000 cases of hepatitis A were reported in the United States.
Who is at risk for hepatitis A?
Hepatitis A can affect any person anywhere in the world. In the United States, hepatitis A occurs in isolated cases to widespread epidemics. Those most at risk include:
- household contacts of infected persons
- sexual contacts of infected persons
- international travelers
- day-care center employees
- day-care center attendees
- men who have sex with men
- injectable drug users
How is hepatitis A transmitted?
Transmission of hepatitis A generally results from ingesting the virus, which is shed in the feces of an infected person. In other words, it commonly is spread when people fail to wash their hands after using the bathroom. Close personal contact is the most common form of hepatitis A transmission, demonstrated by high rates of infection among household members and sexual contacts of those with the virus. Children in day-care centers where there have been outbreaks are at high risk. Diaper-changing tables, if not cleaned properly or changed after each use, may facilitate the spread of hepatitis A. Day-care workers also are at risk since fecal residue may remain on their hands after changing soiled diapers.
Contaminated food and water also can serve as vehicles of hepatitis A transmission. Food-related outbreaks usually are the result of either uncooked or improperly cooked foods or properly cooked foods touched by infected individuals. Transmission also can occur from ingesting water from sewage-contaminated areas where hepatitis A is present. The hepatitis A virus can contaminate all types of water supplies, including swimming pools and lakes. Consuming raw shellfish from these contaminated areas also can result in a hepatitis A infection.
It takes hepatitis A about 30 days to become active in a person’s body; however, an infected individual can transmit the virus to others as early as two weeks before the appearance of symptoms.
What are the symptoms of hepatitis A?
Most patients infected with the hepatitis A virus experience symptoms that tend to mimic the flu, including:
- fatigue
- nausea
- pain in the area of the liver or upper abdomen
- dark urine
- light-colored stools
- fever
Yellowing of the skin or whites of the eyes, known as jaundice, also occurs in many adults infected with the hepatitis A virus. The faded yellow color is the result of the liver malfunctioning. This form of liver inflammation is quite harmless and takes a few weeks to appear.
Once recovered from the virus, the individual is immune to hepatitis A and will not experience another infection. Symptoms will disappear over a six- to 12-month period until complete recovery is achieved, and most people will recover without any serious or long-term health problems.
How is hepatitis A diagnosed?
Hepatitis A is diagnosed by a simple blood test.
What treatment is available for hepatitis A?
There is no specific treatment for hepatitis A. People infected with the virus should get bed rest and drink extra fluids. Alcoholic beverages should be avoided for six months. It is also recommended to avoid intimate contact with other people for six months. The infection usually will clear up by itself in a few weeks or months. On average, only one out of 100 people infected with the hepatitis A virus suffers from a sudden and severe infection, which requires immediate medical attention.
Is there a cure for hepatitis A?
There is no known cure for hepatitis A, only preventative measures. Medications used in the treatment of hepatitis A can provide full recovery from this form of hepatitis.
How can hepatitis A be prevented?
The preferred method of prevention is through vaccination. Vaccination causes the body to develop defenses (antibodies) to the hepatitis A virus. Hepatitis A vaccines are made from the inactive hepatitis A virus (synthetic), and they are highly effective in preventing hepatitis A infection. However, the safety of the vaccine when administered during pregnancy has not been determined.
Check with your doctor to determine how many shots are needed. The vaccine provides protection beginning four weeks after the first injection. To receive optimal protection, the first dose of hepatitis A vaccine should be given four weeks prior to the time of desired protection. A second injection is given within six months to 18 months, and results in long-lasting protection for about six to ten years. To get the best results it is important to get all the shots in the series. The vaccine is approved for persons age 2 years and older and is recommended for:
- individuals who have chronic liver disease or clotting factor disorders
- those who have close physical contact with people who live in areas with poor sanitary conditions
- travelers to areas with increased rates of hepatitis A (Africa, Central and South America, Asia, the Middle East, and Russia)
- men who have sex with men
- illegal drug users
- children in populations that have repeated epidemics of hepatitis A
- persons with chronic liver disease
Good hygiene and sanitation can help prevent the spread of the virus. Water should be boiled prior to use if any question of its safety exists. Similarly, in areas where sanitation is questionable, food should be well-cooked and fruits peeled before eating. Anyone planning to travel to areas where hepatitis A is widespread should receive the complete vaccine series before going on the trip.
Dentists, doctors, nurses, laboratory technicians, and others who draw blood, perform surgical procedures, or handle sharp instruments must be informed when a patient has hepatitis A so that adequate precautions can be taken.
Family members and other intimate contacts of those infected with viral hepatitis should be advised to seek medical advice about vaccination.
Can the hepatitis A vaccine be administered to immunocompromised persons, such as those with HIV or AIDS?
Yes. The hepatitis A vaccine can be administered to immunocompromised persons but they may not achieve complete protection from the hepatitis A virus.
Hepatitis B
What is hepatitis B?
Hepatitis B is a serious form of hepatitis, with 350 million carriers worldwide and an estimated 1 million carriers in the United States. Hepatitis B is the result of a virus infection and can cause liver cell damage, leading to cirrhosis, cancer, and death.
What are the statistics for hepatitis B?
- An estimated 1.25 million people are chronically infected with the hepatitis B virus, of whom 20-30 percent acquired their infection in their childhood.
- Each year, approximately 80,000 new hepatitis B infections occur in the United States, and the virus results in 5,000 deaths annually.
- The number of new infections has decreased from 260,000 in the 1980s to about 73,000 in 2003.
- The majority of people infected each year are adults between the ages of 20 and 49.
Who is at risk for hepatitis B?
People may be at risk for hepatitis B if they:
- have multiple sex partners or a diagnosis of a sexually transmitted disease
- are a man who has sex with men
- have sexual contact with an infected person
- are an injection drug user
- are a hemodialysis patient
- are a healthcare professional with an occupational exposure to blood or body fluids
- are a household member or other intimate contacts of a hepatitis B carrier
- have active or ongoing liver disease
How is hepatitis B transmitted?
- Hepatitis B is much more infectious than HIV, the virus that causes AIDS. Hepatitis B is spread through contact with infected blood, seminal fluid, vaginal secretions, and contaminated needles, including tattoo and body-piercing tools.
You could also get hepatitis B from:
- having sex with an infected person without using a condom
- sharing drug needles
- having a tattoo or body piercing done with dirty tools that were used on someone else
- getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way)
- living with someone who has hepatitis B
- sharing a toothbrush or razor with an infected person
- traveling to countries where hepatitis B is common.
An infected woman can give hepatitis B to her baby at birth or through her breast milk.
You can NOT get hepatitis B from
- shaking hands with an infected person
- hugging an infected person
- sitting next to an infected person
What are the symptoms of hepatitis B?
Approximately 30 percent to 40 percent of people with acute hepatitis B infection show no symptoms. Symptoms are less common in children than adults. Symptoms include loss of appetite, jaundice, abdominal pain, nausea, and vomiting. The most common symptoms of hepatitis B occur 25 to 180 days after catching the virus.
How is viral hepatitis B diagnosed?
The only way to know if you have hepatitis B or if you are a carrier of the virus is through a blood test. Three standard blood tests are used to check for the hepatitis B virus:
- HBsAG (hepatitis B surface antigen): A positive result means you are infected with the hepatitis B virus (HBV) and can pass it on to others.
- Anti-HBc (antibody to hepatitis B core antigen): A positive test result means you currently are infected with HBV or have been infected at some point in the past.
- Anti-HBs (antibody to HbsAg): A positive test result means you are immune to HBV, either as a result of having had the disease or from receiving the vaccine.
People who test positive for the hepatitis B virus (HBsAg) for more than six months are diagnosed as having a chronic infection. This means they were not able to get rid of the virus and it still remains in their liver and blood.
What are the complications of a hepatitis B infection?
Most adults (90 percent) who are infected with the hepatitis B virus will recover completely without incident. Unfortunately, this is not true for infants and young children. Approximately 90 percent of infants and up to 50 percent of young children infected with hepatitis B will not get rid of the virus and will develop a chronic infection. A smaller number of infected adults (5 percent to 10 percent) will also become chronically infected with hepatitis B.
In some people with chronic hepatitis B, the virus continues its silent attack on the liver over a period of years. Eventually this can lead to cirrhosis, liver failure, or liver cancer.
If you are chronically infected, do not drink any alcohol. Alcohol consumption may cause additional damage to your liver. Avoid combining any drugs (prescribed, over-the-counter, or herbal) with alcohol. Your doctor should check your health status periodically. Do not take any new medications, nutritional supplements, or herbals without first checking with your doctor or a pharmacist.
How is hepatitis B treated?
Five medications are used to treat chronic hepatitis B virus in adults:
- Interferon alfa-2b (Intron A®)
- Peginterferon alfa-2a (Pegasys®)
- lamivudine (Epivir HBV®)
- entecavir (Baraclude™)
- adefovir dipivoxil (Hepsera™)
Interferon alfa-2b (Intron A®) and lamivudine (Epivir HBV®) are the only FDA approved medications for children (more than 2 years old) with chronic hepatitis B infection. Patients will respond differently to different treatment plans. Sometimes a patient may have to try a few different medications before finding the one that works best for him or her. Nearly 95 percent of adults infected with the virus develop antibodies and recover spontaneously within six months. Upon recovery, they develop immunity to the virus and are not infectious to others.
Is there a cure for hepatitis B?
Individuals who contract hepatitis B can fully recover with treatment; however, some individuals do develop chronic hepatitis B so they must receive ongoing treatment. The best protection against hepatitis B is through vaccination.
Is hepatitis B preventable?
The preferred method of prevention is vaccination. A series of three injections is given on a specific schedule to provide protection from the virus. Infants who receive all three injections have a 95 percent chance of being safe from hepatitis B for life. The hepatitis B vaccine is not recommended for use after exposure to the virus.
The following recommendations are additional methods of prevention:
- Practice safe sex (use latex condoms).
- Do not share anything that could have an infected person’s blood on it (e.g., toothbrushes, razors, nail clippers, and body-piercing instruments).
- Do not share drug needles, cocaine straws, or any drug paraphernalia.
- Cover all sores and rashes, and do not touch them or allow anyone else to touch them.
- Clean up any blood spills with a 10 percent solution of household bleach.
- Do not pre-chew food for babies if you have the hepatitis B infection.
- Get vaccinated against the hepatitis B virus if you live in the same household with a chronically infected individual.
- Have your children—from newborns and children up to the age of 19—vaccinated against hepatitis B.
- Get vaccinated against hepatitis B if you have a job at which you are exposed to blood.
- Get vaccinated against hepatitis B if you have multiple sex partners.
Can the hepatitis B vaccine be given to immunocompromised persons, such as those with HIV or AIDS?
Yes. The hepatitis B vaccine can be given to immunocompromised persons.
Are there any special concerns for pregnant women with hepatitis B?
From the last few months of pregnancy to the time of delivery, the presence of the hepatitis B virus in the mother can be a significant risk to the newborn. As many as two-thirds of these infants can become infected with the hepatitis B virus, and the majority develop a chronic infection or become carriers. Any pregnant woman who is either a carrier of hepatitis B or infected with an acute or active case should inform her doctor so that her infant can be given special medications and a vaccination. These can prevent the infant from becoming a lifelong carrier of the virus.
Hepatitis C
What is hepatitis C?
Hepatitis C, which is caused by a virus, progresses very slowly and may take 20 years to 30 years before causing serious liver damage. Chronic hepatitis C refers to infections that do not clear up within six months after an acute infection. Less than 3 percent of those infected with hepatitis C die from the disease.
What are the statistics for hepatitis C?
An estimated 3.9 million people in the United States have been infected with hepatitis C, of which 2.7 million are chronically infected. Most people with chronic hepatitis C have yet to be diagnosed. Since these people are likely to seek medical care in the next decade, the projected number of adults diagnosed with chronic hepatitis C is expected to increase fourfold from 1990 to 2015. An estimated 10,000 to 12,000 deaths yearly occur from complications of hepatitis C.
In the United States, there are roughly 25,000 new hepatitis C infections per year. Of these cases, 20 percent are symptomatic. Although treatments are available for hepatitis C, only 15 percent to 25 percent resolve the infection, and those who do not become chronically infected. Of those with a chronic infection, 70 percent develop chronic liver disease, which may progress to cirrhosis, liver cancer, and liver failure.
Who is at risk for hepatitis C?
Those at risk for contracting the hepatitis C virus include the following:
- Anyone who has had a blood transfusion prior to 1992 or has received clotting factors produced before 1987
- Hemodialysis patients
- Injectable drug users
- Persons who have received tattoos or body piercing with unsterile instruments
- Those with multiple sex partners
- Those with partners who have sexually transmitted diseases
- Healthcare workers
- Infants born to infected mothers
How is hepatitis C transmitted?
Hepatitis C primarily is transmitted through contact with contaminated blood, such as blood transfusions or the sharing of needles. Other means of transmission may include contaminated needles used in body piercing, acupuncture, and tattooing. Although sexual contact is not a primary mode of transmission, individuals with multiple sex partners are at increased risk. Straws shared when snorting drugs like cocaine are also a potential source of hepatitis C. The carrier-state of hepatitis C can be identified by a blood test. This blood test can be performed in blood banks, hospitals, and medical laboratories.
As with hepatitis B, hepatitis C can be passed from an infected mother to her newborn infant. However, unlike hepatitis B, hepatitis C can not be passed from an infected mother to her infant through breastfeeding.
Hepatitis C is not spread through kissing, hugging, or casual contact.
What are the symptoms of hepatitis C?
Most people who are infected with hepatitis C do not have symptoms and lead a normal life. If symptoms are present, they may be very mild. Symptoms of hepatitis C can include:
- jaundice
- fatigue
- abdominal pain
- loss of appetite
- intermittent nausea
- intermittent vomiting
- dark urine
How is hepatitis C diagnosed?
Infection by the hepatitis C virus can be determined by a blood test. This test is not performed as part of a routine physical, so people must ask their doctor for a hepatitis C test. If the initial test is positive, a second test should be done to confirm the diagnosis and rule out laboratory error. A liver biopsy can identify the type and degree of liver damage and determine the severity of the disease. The most common way a liver sample is obtained is by inserting a needle into the liver. This can be done in the hospital, and the patient can be sent home within three to six hours if there are no complications.
What treatment is available for hepatitis C?
Interferons (Intron A®, Roferon®, Infergen®), pegylated interferons (Peg-Intron®, Pegasys®), and ribavirin (Rebetol®, Copegus®) currently are approved by the Food and Drug Administration (FDA) for the treatment of chronic hepatitis C.
The current standard of treatment for hepatitis C is the combination of pegylated interferon and ribavirin. Interferon is an immune-boosting drug that works by protecting healthy liver cells and preventing the hepatitis C virus from multiplying. Pegylated interferon is a new formulation that stays active in the blood for a longer period of time. That means patients would not have to give themselves as many injections as they would on non-pegylated interferon. Patients taking interferon and pegylated interferon may experience side effects, such as flu-like symptoms, headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.
Ribavirin is an antiviral medication that prevents the virus from multiplying. Ribavirin is available as a capsule or a tablet, and should be taken twice daily. The side effects of ribavirin may include low red blood cell count (anemia), birth defects, and depression. Women who are pregnant or who are planning pregnancy—or their male partners—should not take ribavirin. Pregnancy should not be attempted until six months after treatment is ended. Ribavirin should only be taken in combination with interferon or pegylated interferon.
Hepatitis C treatment usually lasts about six months to 12 months, depending on the type of hepatitis C and sustained viral response (SVR). The six known types of hepatitis C virus are called “genotypes.” Approximately 70 percent of people infected with hepatitis C in the United States have genotype 1. These patients do not respond as well to therapy as people with the other 5 genotypes. According to the latest medical research, it is recommended that people with genotype 2 or genotype 3 receive treatment for six months, while people with genotype 1 receive treatment for 12 months. Sustained viral response also determines the length of therapy. SVR is defined by the absence of detectable hepatitis C virus in the blood after 6 months or more of treatment. People who do not achieve SVR at month 6 are considered to be non-responsive to treatment, and the doctor may consider discontinuing hepatitis C therapy. Treatment for children with hepatitis C and patients co-infected with HIV-HCV currently is under investigation.
Many pharmaceutical companies and the National Institutes of Health are conducting research to find more effective treatments and cures. Currently, nearly one-half of all liver transplants in the United States are performed for end-stage hepatitis C. However, reinfection of the transplanted liver usually occurs, and a second transplant may be required. Researchers are reexamining when treatment should begin, how long it should continue, and its effectiveness.
Is there a cure for hepatitis C?
Very few individuals fully recover from hepatitis C, as most cases become chronic, even with treatment. There is no preventive vaccine for hepatitis C; only behavior modifications (including practicing safe sex and not sharing razors, toothbrushes, scissors, or nail clippers) help prevent exposure to hepatitis C.
How can hepatitis C be better managed?
If you have hepatitis C, try to maintain as normal a life as possible, follow a well-balanced diet, exercise, and keep a positive attitude. Avoid overwhelming tasks, and learn how to pace yourself. Rest when you feel tired, and plan physically exhausting tasks for the morning when your energy level is at its peak.
If you are a hepatitis C patient on medication, taking your medicine as prescribed is extremely important. Staying compliant with your medications helps the medications work more effectively and allows you to get the best response from them.
How can viral hepatitis C be prevented?
Unlike hepatitis A and B, there are no vaccines to prevent hepatitis C. Preventive measures include screening blood, organ, and tissue donors, as well as changing risky behaviors and using blood and body fluid precautions.
Do not share drug needles, cocaine straws, or any drug paraphernalia. Practice safe sex (use latex condoms), and get vaccinated against hepatitis A and B.
Avoid handling anything that may have the blood of an infected person on it, such as razors, scissors, toothbrushes, nail clippers or files, and tampons or sanitary napkins. Wipe down any item that has blood on it with detergent and a 10 percent solution of household bleach, since this combination is believed to kill the virus.
Can a person be reinfected with viral hepatitis?
Yes. Since there are several different hepatitis gene combinations (genotypes), a person can acquire different hepatitis infections. Moreover, prior infection does not necessarily protect the person against the same virus genotype that caused the initial infection. The reason is that changes can occur in parts of the virus that are not recognized by pre-existing proteins that the immune system has produced to defend the body against foreign substances (antibodies).
I think I’ve been infected with hepatitis. What should I do?
Consult your doctor, who will perform a physical examination and order blood work and other tests to confirm a diagnosis. If you test positive for any form of viral hepatitis, your close contacts (those who could be exposed to the virus) should be advised of the infection and speak with their doctors on what course of action is next.
How can Walgreens Specialty Pharmacy help?
If you have hepatitis, it is important to find a pharmacy that understands the complexities of hepatitis medications. Walgreens Specialty Pharmacy was created to take the time-consuming tasks of medication management out of the hands of hepatitis patients. Specially trained Walgreen pharmacists join your treatment team, working hand in hand with your doctor and other healthcare providers, to support their services and help ensure that you receive the best results from your hepatitis therapy.
Where can I find more information on viral hepatitis?
- American Liver Foundation
www.liverfoundation.org - Hepatitis Foundation International
www.hepfi.org - Centers for Disease Control and Prevention
www.cdc.gov
Inclusion of resources on this list does not imply endorsement by Walgreen Co. or any of its subsidiaries or affiliates. These resources should be used for general information and educational purposes only. Information provided by these resources should not replace necessary medical consultations with a qualified health or medical professional.
Information provided here does not constitute professional medical advice. Although it is intended to be accurate, neither Walgreen Co., its subsidiaries or affiliates, nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional.