Hepatitis is a disease or infection that attacks the liver. When an individual is infected with hepatitis, their liver may swell or start to shut down, leading to tiredness, jaundice (yellowing of the skin and eyes), and even liver cancer.

Hepatitis A

Hepatitis A is a viral infection transmitted by unknowingly ingesting the virus from objects, food, or drinks contaminated with small, undetected amounts of stool from an infected person. 

Not everyone with Hepatitis A will show symptoms, but many do.

Exposure to hepatitis A occurs most typically from contaminated food or drink, but can also happen during close person-to-person contact, sexual activity, and from unsanitary conditions, including using unsterile cooking, smoking, or injection equipment when using drugs. Individuals who are homeless are especially at risk for infection. Unlike HIV, hepatitis A can live outside the body for several months.

Not everyone infected with hepatitis A will show symptoms, but many do, including fever, loss of appetite, nausea, diarrhea, and jaundice.

There is a vaccine for hepatitis A, but no specific medication or cure.

It is a good idea for people who use drugs, or who may be living or intimate with someone who has hepatitis A, to get vaccinated.

For those at risk, it's a good idea to get vaccinated.

Historically, hepatitis A is not very common in the US—between 2012 and 2016, there were fewer than 8,000 cases nationwide—but recently there have been large outbreaks of hepatitis A among those experiencing homelessness and/or using both injection and non-injection drugs. In 2018 alone, there were more than 7,000 cases across 12 states. Given these recent outbreaks, it’s important to be vigilant about preventing hepatitis A infection and for those at risk for hepatitis A to get vaccinated.

For those at risk of hepatitis A, take these steps to prevent infection:

• Use sterile needles and injection paraphernalia every time. These can often be obtained from a local syringe services program or harm reduction center.
• Use a sterile space to prepare and consume drugs.
• Use good personal hygiene and proper sanitation, including washing your hands regularly.
• Get vaccinated for hepatitis A. The vaccine, given as 2 shots over 6 to 12 months, is appropriate for most people, and protects against hepatitis A infection for at least 20 years.

Hepatitis B and C

Hepatitis B and C are transmitted when infected blood enters the blood of someone who is not infected. Hepatitis B is also transmitted when sexual fluid enters the blood of someone who is not infected.

People can be exposed to the hepatitis B or C virus through:

• sexual activity (including oral, vaginal, and anal sex)
• sharing personal items that may have touched blood (including toothbrushes, razors, nail clippers, and injection equipment),
• sharing equipment that has pierced the skin (including syringes for injecting medication or other materials, tattoo needles, and piercing equipment)

Most individuals infected with hepatitis B or C will not know they are infected with the virus for several months or even years.

That’s why it’s important for those at risk to get tested regularly so that they can start treatment as soon as possible, if needed. In some cases, the body may clear the hepatitis on its own (these first 6 months of infection are known as acute hepatitis), but this is much less common than the body continuing to be infected (chronic hepatitis).

There is a vaccine and treatment for hepatitis B, but no cure.

It is a good idea for those who use drugs, those who are engaged in sex work, and those who may be living or intimate with someone who has hepatitis B, to get vaccinated. 

For Hepatitis C, there is no vaccine, but there is a cure.

For those using drugs, hepatitis B and C can be spread through contaminated needles or injection paraphernalia. This includes syringes, cookers, cottons, water containers, and surfaces used to prepare or inject drugs. The viruses can also be spread through contaminated smoking pipes. This means that using drugs via methods that may bring contact with blood, including sharing pipes for smoking crack or meth when one individual has cracked or bleeding lips, can also be a risk factor (though not as high risk as sharing needles). Unsafe sexual practices are another risk factor.

In the US, injection drug use is the most common risk factor for Hepatitis B.

Currently, as many as 2.2 million individuals in the US are living with chronic hepatitis B, and during 2016 there were an estimated 20,900 new cases of acute hepatitis B. Global estimates indicate that between 1 in 20 and 1 in 10 individuals who inject drugs are infected with hepatitis B, and in the US, injection drug use is the most common risk factor for becoming infected.

About 3.5 million people in the US are now living with chronic hepatitis C, and in 2016, there were an estimated 41,200 new cases of acute hepatitis C. Global estimates indicate that between 3 in 5 and 4 in 5 individuals who inject drugs are infected with hepatitis C.

For those at risk of hepatitis B and C, take these steps to prevent infection:

• Use sterile needles and injection paraphernalia every time. These can often be obtained from a local syringe services program or harm reduction center.
• Do not share personal hygiene items. This includes not sharing toothbrushes, razors, or nail clippers with someone who is infected with hepatitis, or whose hepatitis status you do not know.
• Use condoms every time during oral, vaginal, or anal sex.
• Get tested for hepatitis B and C regularly. Knowing your own hepatitis B and C status as well as your partner/partners’ status can help you take steps to protect yourself and those you care about.
• Get vaccinated for hepatitis B. The vaccine, given as 2, 3, or 4 shots over 1 to 6 months, is appropriate for most people, and protects against hepatitis B infection for at least 30 years.