It’s World Hepatitis Day today and we spoke with Kathryn Dye, FNP from Piedmont HealthCare’s Comprehensive Digestive Care Center!
First, the difference between Hepatitis A,B,C,D, and E
Hepatitis A is caused by the hepatitis A virus (HAV), transmitted primarily via the fecal-oral route, often through contaminated food or water.
Prevention relies on improved sanitation, safe water, and vaccination*.
Management is supportive, as the disease is self-limited in most cases; no specific antiviral therapy is indicated.
**For hepatitis A, the United States Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend a 2-dose series of inactivated hepatitis A vaccine for all children at age 12–23 months, with the second dose administered 6–18 months after the first. For adults and older children who have not been previously vaccinated, the same 2-dose schedule applies, with Havrix (0, 6–12 months) or Vaqta (0, 6–18 months) as options. The combined hepatitis A and B vaccine (Twinrix) can be used in adults ≥18 years as a 3-dose series at 0, 1, and 6 months, or on an accelerated schedule at 0, 7, and 21–30 days with a booster at 12 months.
Hepatitis B is caused by the hepatitis B virus (HBV), transmitted through blood, sexual contact, and perinatally.
Prevention includes universal vaccination*, safe injection practices, and screening of blood products.
(If you have Hepatitis B) ➡️ Chronic HBV infection is managed with nucleos(t)ide analogues (e.g., entecavir, tenofovir) to suppress viral replication and reduce the risk of cirrhosis and hepatocellular carcinoma.
** For hepatitis B, the CDC and ACIP recommend universal vaccination for all infants, with the first dose at birth, followed by additional doses at 1–2 months and 6–18 months. For unvaccinated adults aged 19–59 years, a 2-dose series of Heplisav-B (0, 1 month) or a 3-dose series of Engerix-B or Recombivax HB (0, 1, 6 months) is recommended. The combined hepatitis A and B vaccine (Twinrix) is also an option for adults, following the same 3-dose or accelerated schedule as above. Special schedules exist for immunocompromised individuals and those on hemodialysis.
These recommendations are based on guidelines from the United States Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.
Hepatitis C is caused by the hepatitis C virus (HCV), transmitted mainly via blood exposure (e.g., injection drug use, transfusions before screening).
There is no vaccine.
Prevention focuses on harm reduction and blood safety.
Direct-acting antiviral (DAA) regimens (e.g., sofosbuvir/velpatasvir) are first-line and can cure >95% of cases, with treatment tailored to genotype and comorbidities.
***Hepatitis B and hepatitis C screening tests are covered for free by insurance under the Affordable Care Act (ACA) in the United States, provided the screening is performed according to recommendations from the United States Preventive Services Task Force (USPSTF).
For hepatitis C, the USPSTF recommends one-time screening for all adults aged 18 to 79 years, and periodic screening for those with ongoing risk factors. This recommendation is rated “B,” which means that, under the ACA, most private insurance plans and Medicaid expansion programs must cover the test without cost-sharing when performed in accordance with these guidelines. The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America also recommend universal HCV screening for adults, further supporting coverage.
For hepatitis B, the USPSTF recommends screening for individuals at increased risk, including people born in regions with high HBV prevalence, people who inject drugs, men who have sex with men, and others with specific risk factors. This is also a “B” recommendation, so insurance coverage without cost-sharing applies when screening is performed for these risk groups. The American Association for the Study of Liver Diseases and the Centers for Disease Control and Prevention also recommend screening in these populations.*****
Hepatitis D is caused by the hepatitis D virus (HDV), which requires HBV co-infection. Transmission mirrors HBV.
Prevention is via HBV vaccination.
Management of chronic HDV includes pegylated interferon-alpha; bulevirtide is approved in some regions for compensated liver disease, but options remain limited.
Hepatitis E is caused by the hepatitis E virus (HEV), transmitted via the fecal-oral route, often through contaminated water or zoonotic sources.
Prevention includes improved sanitation and in some countries vaccination (ex. available commercially in China and Pakistan at this time).
Most cases are self-limited; ribavirin may be used in severe or chronic cases, particularly in immunocompromised patients.
**Chronic hepatitis B, C, and D are associated with increased risk of cirrhosis and hepatocellular carcinoma, necessitating long-term monitoring and management**
More information about Hepatitis from Kathryn Dye, FNP:
- Urgent action is needed to overcome financial barriers: Many countries, especially those with high hepatitis burden, lack sufficient funding for screening, diagnostics, and treatment programs. Innovative financing and government subsidization are essential to ensure equitable access to care and to meet the World Health Organization (WHO) 2030 elimination targets.
- Social and systemic barriers persist: Marginalized and underprivileged populations face disproportionate barriers to hepatitis care, including limited awareness, complex healthcare navigation, and inadequate linkage to treatment. Tailored, community-based interventions are critical to reach these groups and improve outcomes.
- Stigma remains a major obstacle: Stigma and discrimination against people living with hepatitis B and C hinder testing, diagnosis, and ongoing care, contributing to underdiagnosis and ongoing transmission. Public education and destigmatization campaigns are vital to encourage early detection and engagement in care.
- Liver cancer prevention is integral to hepatitis elimination: Chronic hepatitis B and C are leading causes of hepatocellular carcinoma. Scaling up vaccination, early diagnosis, and antiviral therapy are proven strategies to reduce liver cancer incidence and mortality.
- Coordinated, multisectoral action is required: National action plans, simplified models of care, and integration of hepatitis services into primary care are necessary to accelerate progress and close gaps in the care cascade
To schedule an appointment at the Comprehensive Digestive Care Center:
- Visit their website here.
- Call 704-978-1144 for the Statesville location.
- Call 704-235-1829 for the Mooresville location.
Kathryn Dye, FNP
