Hepatitis is an inflammation of the liver caused by a hepatitis virus. Although there are several types of hepatitis infections, the three most common in the United States are Hepatitis A, B, and C. Hepatitis A is primarily transmitted through fecal contamination of food and water as well as anal or oral contact. It is also considered the least threatening since it usually does not lead to liver damage and 99% of those infected are able recover fully. Hepatitis B and Hepatitis C are serious viral diseases that can become chronic and attack the liver. They are blood-borne viruses that require contact with infected blood and body fluids.

Hepatitis A (HAV)

Read the Hepatitis A Fact Sheet [PDF]

HAV is usually spread from one person to another by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A infection. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas with poor sanitary conditions or where good personal hygiene is not consistently observed. There is a vaccine for HAV. HAV does not lead to a chronic infection.

• Rimming and any other contact with the stool of a person with hepatitis A (For example, putting your mouth on your partner’s anus, putting anything that has been near your partner’s anus in your mouth such as fingers, sex toys, etc.).
• Changing diapers (i.e., daycare setting).
• Drinking water or using ice that is contaminated with feces.
• Eating food – particularly food that is raw or not thoroughly cooked – that has been handled or prepared by someone who has acute hepatitis A (and may not know it).
• Eating contaminated shellfish that have not been properly cooked.
• Very rarely, hepatitis A can be transmitted through blood-to-blood contact, for example through injection drug use.

Who is most at risk for HAV infection?

• Household contacts of infected people.
• Sexual contacts of infected people.
• People traveling to countries where HAV is common.
• Men who have sex with men.
• Individuals who engage in rimming (oral/anal sex).
• Injecting and non-injecting drug users.
• People, especially children, living in areas with increased rates of hepatitis A during 1987-1997.

What are the best ways to prevent Hepatitis A transmission?

• Hepatitis A vaccination is the best protection. (Kindly click on our hepatitis resources to locate DC hepatitis vaccination sites)
• Always wash hands with soap and water after using the bathroom, after changing a diaper, and before preparing and eating food.
• Use gloves (i.e., when changing diapers or engaging in any other risk activity).
• Harm reduction for oral/anal sex and injection drug use (IDU).
• Avoid undercooked or raw shellfish.
• Short-term protection against HAV infection is available from immune globulin; it can be given before and within two weeks after coming in contact with HAV.

Hepatitis B (HBV)

Read the Hepatitis B Fact Sheet [PDF]

Hepatitis B virus is spread through contact with the blood and certain other body fluids of an infected person. HBV is very similar to HIV in the ways that it is transmitted, but is more easily transmitted. In people with HBV, the virus is present in blood, semen, and vaginal fluids. There is a vaccine for HBV. HBV can also lead to a chronic condition.

What are the most common ways that hepatitis B (HBV) virus transmission occurs?

• Unprotected sexual activity.
• Sharing injection drug equipment (including needles, cookers, tourniquets, and water).
• Needlesticks or sharps exposures on the job (healthcare workers).
• Tattooing.
• During birth, when the virus passes from an infected mother to her baby.
• The use of contaminated surgical instruments or donor organs from people with HBV.
• Contact with open sores of someone with HBV.
• Household transmission of HBV may occur when blood or body fluids of the infected person comes in contact with that of another household member.

Who is most at risk for HBV infection?

• People who have more than one sex partner within six months.
• People with a history of a sexually transmitted disease (STD).
• Men who have sex with other men (MSMs).
• Sexual contacts of people with HBV infection.
• People who share injection drug equipment.
• Healthcare workers and public safety workers who might be exposed to infected blood or body fluids.
• Certain household contact of people with chronic HBV infection.
• Dialysis patients.

What are the best ways to prevent Hepatitis B transmission?

• Hepatitis B vaccination is the best protection. (Kindly click on our hepatitis resources to locate DC hepatitis vaccination sites)
• To reduce mother to infant transmission, pregnant women should get a blood test for hepatitis B.
• People having sex with a partner of unknown HBV status should use latex condoms or other latex barriers correctly and every time.
• Harm reduction options including not sharing drugs, needles, syringes, water, or other works that can be contaminated with blood
• People who shoot drugs should be offered vaccination for hepatitis A and hepatitis B and a referral to a drug treatment program.
• People getting a tattoo should be encouraged to seek a commercial establishment that follows proper procedures for sterilizing all tools or uses only new sterile tools. People getting a tattoo outside of a commercial establishment (for example, street tattoos, jail tattoos, etc.) should be encouraged to use only sterile tools, clean tools in bleach, and avoid sharing ink.

Hepatitis C (HCV)

Read the Hepatitis C Fact Sheet [PDF]

Hepatitis C virus is transmitted through direct blood-to-blood contact. Any activity that lets one person’s blood come into contact with another person’s blood can potentially transmit HCV. Transmission can occur by sharing needles or other “works” to inject drugs; high-risk sex with an infected person; occupational exposure to infected blood; tattooing/body piercing with contaminated equipment; mother-to-infant; the use of blood products such as clotting factor prior to 1988 and, through blood transfusions and tissue transplants prior to mid-1992. Transmission through intranasal drug use (i.e. sharing straws to snort drugs) is still unclear. There is no vaccine for HCV. HCV can also lead to a chronic condition.

What are the most common ways that hepatitis C (HCV) virus transmission occurs?

• Sharing injection drug equipment (including needles, cookers, tourniquets, and water).
• Needlesticks or sharps exposures on the job (healthcare workers).
• Unprotected sexual activity.
• Tattooing.
• During birth, when the virus passes from an infected mother to her baby.
• The use of contaminated surgical instruments or donor organs from people with HCV.
• Household transmission of HCV may occur when blood or body fluids of the infected person comes in contact with that of another household member.
• Intranasal Drug Use

Who is most at risk for HCV infection?

• Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile instruments
• People with known exposures to the hepatitis C virus, such as
• Healthcare workers injured by needlesticks
• Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
• HIV-infected persons
• Children born to mothers infected with the hepatitis C virus
• Sexual contacts of people with HCV infection.
• Certain household contact of people with chronic HCV infection.

What are the best ways to prevent Hepatitis C transmission?

• Avoid sharing injection drug equipment (needles, syringes, water, cookers, cottons, tourniquets, etc.).
• Avoid sharing tattooing equipment, razors, toothbrushes, and other implements that might hold blood.
• Avoid sharing straws for intranasal drug use.
• Follow standard precautions in occupations that involve possible exposure to blood.
• Use a condom or other barrier when having sex.