Viral Hepatitis - The Road Traveled and the Journey Remaining

Figures & data

Table 1 Comparison of Hepatitis Viruses

	Hepatitis A	Hepatitis B	Hepatitis C	Hepatitis D	Hepatitis E
Type of Virus	ssRNA	dsDNA	ssRNA	ssRNA	ssRNA
Discovery	1973	1965	1989	1977	1990
Global Prevalence	• 1.4 million cases per year^Citation106 • Occurs in epidemics	296 million^Citation4	58 million^Citation4	60 million^Citation82	20 million^Citation96
Transmission	Oro-fecal^Citation107	• Parenteral^Citation107 • Vertical • Sexual	Parenteral^Citation107	Parenteral^Citation107	Oro-fecal^Citation107
Incubation Period	2–6 weeks^Citation107	4–26 weeks^Citation107	2–26 weeks^Citation107	4–26 weeks^Citation107	2–8 weeks^Citation107
Chronic State	No	Yes	Yes	Yes	No (may be seen in immunodeficiency states)
Clinical Symptoms	• May be asymptomatic • Symptoms may include:   - Fever   - Fatigue   - Jaundice   - Nausea   - Vomiting   - Anorexia	• May be asymptomatic • Symptoms may include:   - Fever   - Fatigue   - Jaundice   - Nausea   - Vomiting   - Anorexia	• Asymptomatic • Very rarely, symptoms occur in acute infection	Co-infection: Mirrors HBV Super infection: • May be asymptomatic • Symptoms may include:   - Fever   - Fatigue   - Jaundice   - Nausea   - Vomiting   - Anorexia	• May be asymptomatic • Symptoms may include:   - Fever   - Fatigue   - Jaundice   - Nausea   - Vomiting   - Anorexia
Laboratory Diagnosis	Anti-HAV IgM antibodies^Citation107	• HBsAg detection^Citation107 • HBcAg antibodies • HBV DNA PCR	• Anti-HCV antibodies^Citation107 • HCV RNA PCR	• Anti-HDV antibodies^Citation107 • HDV RNA PCR	• Anti-HEV antibodies^Citation107 • HEV RNA PCR
Treatment	Supportive	• Supportive • Anti-viral therapy	• Supportive • Anti-viral therapy	• Supportive • Anti-viral therapy	Supportive
Prevention	• HAV Vaccine • Improving sanitation • Provision of clean drinking water • Appropriate disposal of sewage • Educating the public	• HBV Vaccine • Screening • Educating the public	• Screening • Educating the public	• HBV Vaccine • Educating the public	• HEV Vaccine • Improving sanitation • Provision of clean drinking water • Appropriate disposal of sewage • Educating the public

Abbreviations: ssRNA, single stranded RNA; dsDNA, double stranded DNA; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HDV, hepatitis D virus; HEV, hepatitis E virus; HBsAg, hepatitis B surface antigen; HBcAg, hepatitis B core antigen; PCR, polymerase chain reaction; IgM, immunoglobulin M; IgG, immunoglobulin G.

Lesmanawati DAS, Adam DC, Hooshmand E, Moa A, Kunasekaran MP, MacIntyre CR. The global epidemiology of hepatitis A outbreaks 2016–2018 and the utility of EpiWATCH as a rapid epidemic intelligence service. Global Biosecurity. 2021;3(1). doi:10.31646/gbio.100

 Google Scholar

World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections; 2021.

 Google Scholar

Miao Z, Zhang S, Ou X, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection. J Infect Dis. 2020;221(10):1677–1687. doi:10.1093/infdis/jiz633

 PubMed Web of Science ®Google Scholar

Murrison LB, Sherman KE. The enigma of hepatitis E virus. Gastroenterol Hepatol. 2017;13(8):484–491.

 Google Scholar

Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, PA: Elsevier/Saunders; 2015.

 Google Scholar