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Five main strains of the Hepatitis virus – A, B, C, D and E

By Prof (Dr.) Subhash Gupta in Liver Transplant and Biliary Sciences

Nov 28 , 2020 | 2 min read


This year’s World Hepatitis Day theme is “Hepatitis Free Future”. It strongly focuses on the prevention of Hepatitis B & C among mothers and infants. 9 out of 10 people living with viral hepatitis are unaware of this serious infection and how it could be fatal if not monitored. There are five main strains of the hepatitis virus – A, B, C, D and E. Together, hepatitis B and C are the most common cause of deaths, with 1.3 million lives lost each year. Amid the COVID-19 pandemic, viral hepatitis continues to claim thousands of lives every day. 325 million people worldwide who are living with viral hepatitis B & C need to be diagnosed and linked to clinicians to prevent death and disease. We need to scale up testing, treatment and vaccination so that the goal of “hepatitis elimination by 2030” can be achieved. 

The good news is that all types of viral hepatitis can be controlled or prevented. Hepatitis A and E virus are transmitted by fecal-oral transmission through contaminated food or water and it can be prevented by improved sanitation. Symptoms for Hepatitis A and E include Jaundice, loss of appetite, vomiting, and joint pain. Hepatitis A vaccination needs to be incorporated widely in the immunization schedule as a preventive measure. Although mostly a self-limited illness, Hepatitis A and E infection in a small proportion of patients can have a fulminant presentation and would require urgent admission in the ICU, and even liver transplant in extreme cases. 

Hepatitis B is commonly spread from mother to child at birth through perinatal transmission and horizontal transmission. It is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and, menstrual, vaginal, and seminal fluids. Hepatitis B and C infection cause chronic liver disease, cirrhosis and liver cancer and if not diagnosed in time, antiviral drugs can cure or at least control disease progression. Research is ongoing for the cure of hepatitis B but at the current moment, antiviral drugs can only prevent viral multiplication. Hepatitis free future is achievable with a focus on infection prevention in newborns, pregnant women should be routinely tested for Hepatitis B, HIV, and Syphilis. The focus is on eliminating of hepatitis B by universal vaccination. Some countries such as Taiwan have almost eliminated hepatitis B infection by screening pregnant women and vaccinating newborns. Childhood infection results in an asymptomatic carriage and thereby results in widespread transmission as opposed to infection acquired in adulthood where most individuals will clear the infection spontaneously.

The biggest discovery of this decade has been the successful drug therapy for hepatitis C, a blood-borne virus spread through the sharing of injection equipment, lack of sterilization of medical equipment. Majorly, people infected with Hepatitis C do not exhibit any symptoms but those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting and many more.

Apart from the vagaries of chronic hepatitis B and C infection, we need to work on lifestyle measures such as preventing alcohol abuse, minimizing obesity, controlling diabetes, and preventing drug-induced liver injury. Hepatocellular cancer goes hand in hand with chronic hepatitis and therefore screening and surveillance has an important role in decreasing the morbidity and mortality from this unfortunate sequelae.