What’s the Difference Between Hepatitis A, B and C?

You’ve probably seen stories in the news about hepatitis A outbreaks linked to infected restaurant workers, or how a rising rate of hepatitis C infections is causing increased health care costs.

But you might not know the difference between hepatitis A, B and C, or why you should be concerned about them.

Here’s why: Hepatitis, or inflammation of the liver, affects more than 50,000 new people each year and is a leading cause of liver cancer and liver transplants. The Centers for Disease Control and Prevention (CDC) estimates as many as 6 million people in the U.S. are living with hepatitis.

Having hepatitis can be dangerous and uncomfortable. Symptoms are similar for hepatitis A, B and C and may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored stools, joint pain and jaundice (a yellowing of the eyes and skin). Even worse, chronic hepatitis often has no symptoms, and people don’t know they’re infected until they get very sick.

Michael Fried, MD, director of the UNC Liver Center, explains the difference between the types of hepatitis and how to protect yourself.

Hepatitis A

About 2,500 new hepatitis A infections happen in the U.S. each year. People infected with hepatitis A can be sick for a few weeks to a few months, but most recover with no lasting liver damage.


People usually get hepatitis A from eating or drinking something that has been contaminated with a small amount of the virus, sometimes contained in fecal matter. This can happen when a person with hepatitis A infection goes to the bathroom, doesn’t wash his hands and then handles or serves food.


No medications or other treatments will cure hepatitis A infection, so medical treatment is aimed at making sure the person gets plenty of rest, fluids and adequate nutrition. Fortunately, most people who get sick with a hepatitis A infection get over it, and it doesn’t become a chronic illness.


There is an effective vaccine against hepatitis A that is recommended for all children at age 1. However, most adults probably have not received it because the vaccine wasn’t required when they were young. Dr. Fried says you can come in contact with the hepatitis A infection pretty much anywhere, so it’s a good idea for everyone older than 1 to get the vaccine, whether or not they’ve had any known exposure or traveled to regions where hepatitis A is common.

In addition to getting vaccinated, you should wash your hands every time you go to the bathroom and before handling or serving food or drinks. Also be sure to wash and rinse raw produce before eating or serving it. Cooking raw produce further reduces the risk of infection.

Hepatitis B

The CDC estimates that 850,000 to 2.2 million people in the United States live with chronic hepatitis B, and there are about 19,200 new infections each year. Hepatitis B can become a serious, lifelong condition.


In the U.S., people usually get hepatitis B infection through sexual transmission or intravenous drug use. In other parts of the world where hepatitis B is more common, such as Southeast Asia, mother-to-child transmission at birth is the most common way people get infected. Unlike hepatitis A infection, hepatitis B has the potential to become a chronic infection that requires lifelong management.


Like hepatitis A, medical treatment for acute hepatitis B is focused on getting plenty of rest and fluids and eating a healthy diet, although sometimes antiviral drugs are recommended for severe cases to help prevent liver failure. Patients with chronic hepatitis B may be given an oral antiviral drug to control the viral infection and minimize liver damage. These drugs are effective, but they rarely cure chronic hepatitis B. Therefore, these medications often have to be taken for life.


Dr. Fried emphasizes that hepatitis B infection can be prevented by avoiding risky behaviors involving sex and drugs and by getting vaccinated. The hepatitis B vaccination is required for infants at birth, and subsequent vaccinations for adults are also important. There are separate vaccines for hepatitis A and B, but there is also a combination A and B vaccine so you can take care of both types at once. In North Carolina, newborn vaccinations have been required since 1994. Anyone born before this year should talk to their health care provider about being vaccinated for hepatitis B.

Hepatitis C

Hepatitis C affects as many as 4 million people in the U.S., and many of them don’t know they have the infection because it’s usually asymptomatic until the advanced stages of disease. More than 50 percent of patients who get infected with hepatitis C go on to chronic infection. It’s estimated that about 120,000 people in North Carolina have chronic hepatitis C, and new infections have been increasing.

Hepatitis C disproportionately affects baby boomers, which is why the CDC recommends hepatitis C screenings with a simple, inexpensive blood test for anyone born between 1945 and 1965.


Hepatitis C can be contracted only through direct blood contact. In the U.S., the primary mode of transmission is blood exposure through sharing needles. Mother-to-child transmission is about 5 percent of cases. Hepatitis C infection might also be a risk for people who received a blood transfusion or an organ transplant before 1992, when widespread testing of the blood supply for hepatitis C began.


When Dr. Fried started treating hepatitis C in 1990, the cure rate was 7 percent. Treatments have evolved since then, leading to a 95 percent cure rate. The treatment course includes taking one to a few pills a day for 12 to 24 weeks, and the medicines have few side effects. Hepatitis C is the only chronic viral infection that you can routinely cure, thanks to these new medicines.


Unfortunately, there is no vaccine available for hepatitis C, but you can protect yourself by avoiding behaviors such as sharing needles and syringes. In addition, the CDC recommends people born between 1945 and 1965 get tested for hepatitis C. Testing is also recommended for people who were treated for blood-clotting problems before 1987 and recipients of blood transfusions or donated organs before 1992.

The UNC Liver Center has a clinic in Chapel Hill that specializes in hepatitis B and C, incorporating the latest clinical trials and most up-to-date therapies. Treatment for hepatitis is also available at our locations in Asheville, High Point, Raleigh and Wilmington. To learn more, call (919) 966-2516.

Michael Fried, MD, is the director of the UNC Liver Center and a professor of medicine at the UNC School of Medicine.