With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!
This is the final installment in a three-part series. You can click the links to view more about hepatitis A and hepatitis C.
What is Hepatitis?
Hepatitis means “inflammation of the liver”. A liver can become inflamed for many reasons, such as too much alcohol, physical injury, autoimmune response, or a reaction to bacteria or a virus. The five most common hepatitis viruses are A, B, C, D, and E. Some hepatitis viruses can lead to fibrosis, cirrhosis, liver failure, or even liver cancer. Damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins.
Hepatitis B vs. Hepatitis E
Globally, hepatitis E is a common liver infection. The World Health Organization estimates that 20 million people are infected each year. The virus has 4 known types: genotype 1, genotype 2, genotype 3, and genotype 4. Genotypes 1 and 2 are primarily spread through fecal-oral transmission or by consuming food or water that has been contaminated and are only found in the human population. Typically, these genotypes are found in Africa, Asia, and Mexico. Poor sanitation and lack of clean water infrastructure contribute to the spread of genotypes 1 and 2.
Genotypes 3 and 4 are found in animal populations and can be passed on to a human if their meat is undercooked and consumed. Pigs, deer, boar, and chickens have all been found to carry the hepatitis E virus, but studies have shown that consuming undercooked infected pig (pork) and wild boar have commonly been the main source of animal-to-human transmission. Although less common, shellfish has also been found to carry the hepatitis E virus as well. Genotypes 3 and 4 are most generally found in China, Taiwan, Japan, and other developed countries.
It is important to remember that hepatitis B is not spread by contaminated food or water. You cannot get hepatitis B by sharing utensils or eating food prepared by someone who is infected. The hepatitis B virus is a blood-borne pathogen, which means that it is only spread through direct blood contact with an infected person’s blood.
Unlike hepatitis B, hepatitis E usually does not progress to a life-long infection. However, the Centers for Disease Control and Prevention (CDC) reports that the number of genotype 3 cases that lead to chronic liver disease are on the rise. In most cases, the infection typically resolves itself after a few weeks. Globally, young people aged 15-40 are considered to be the most at-risk population. Children under 15 generally have no symptoms or develop a mild illness. Young adults will often experience symptoms such as jaundice, vomiting, reduced appetite, and fatigue. At the moment, there are no specific treatment options for hepatitis E. Recommendations include getting plenty of rest and staying hydrated. In extreme cases, hospitalization may be required. Hepatitis E can also lead to fulminant hepatitis, or acute liver failure. Fulminant hepatitis most often occurs with hepatitis E infections in pregnant women and those with weakened immune systems.
Pregnant Women and Hepatitis B/E
Both hepatitis B and E can be transmitted from mother-to-child. This type of transmission is rare for hepatitis E patients but occurs frequently in mothers living with chronic hepatitis B. This is because hepatitis B is a “silent infection”; it often has no symptoms so many mothers do not know that they are infected. It is much less common for hepatitis E to be spread from mother to child because the infection typically resolves itself in 4-6 weeks. The danger with hepatitis E and pregnancy lies within the complications that it can cause. Research has shown that pregnant women have a higher risk of developing fulminant hepatitis than other patients, although more studies need to be conducted to discover the reason why this occurs. Hepatitis E tends to be most dangerous for women in their second and third trimester. According to the CDC, maternal death rates from hepatitis E can reach 10% – 30% in the final trimester. Mothers can also experience severe illness, premature delivery, and the loss of their pregnancy.
With hepatitis B infection, approximately 90% of infants born to hepatitis B infected mothers will develop chronic hepatitis B and have an increased risk of developing liver disease and liver cancer later in life. This can be avoided, however, if certain precautions are taken once the child has been born! By making sure the doctor is aware of the mother’s hepatitis B and having the delivery staff administer 1) the first dose of the hepatitis B vaccine and 2) one dose of the Hepatitis B Immune Globulin (HBIG, if available) in the delivery room, the newborn has more than a 95% chance of being protected for life! After the initial shots are given, it is extremely important to follow through with the vaccination schedule for a lifetime of protection.
Prevention
Hepatitis B can be prevented with a 3-dose vaccine or a 2-dose vaccine for adults where available! While you wait to complete the vaccine series, simple steps to prevent transmission include washing your hands thoroughly with hot water and soap, cleaning surfaces that come into contact with blood with a diluted bleach solution, and not sharing objects that may have trace amounts of blood on them such as razors, toothbrushes, nail clippers and body jewelry. Although there is no vaccine approved for hepatitis E in the United States, there is one available in China. For hepatitis E, genotypes 1 and 2 can be prevented by thoroughly washing your hands after using the bathroom and by boiling water before drinking it. Transmission of genotypes 3 and 4 can be prevented by thoroughly cooking all meat and avoiding undercooked meats. Pregnant women should exercise caution when consuming pork, deer meat, and wild boar.
On the other hand, hepatitis B begins as a short-term infection, but in some cases, it can progress into a chronic, or life-long, infection. Chronic hepatitis B is the world’s leading cause of liver cancer and can lead to serious liver diseases such as cirrhosis or liver cancer. Most adults who become infected with hepatitis B develop an acute infection and will make a full recovery in approximately six months. However, about 90% of infected newborns and up to 50% of young children will develop a life-long infection. This is because hepatitis B can be transmitted from an infected mother to her baby due to exposure to her blood. Many infected mothers do not know they are infected and therefore cannot work with their physicians to take the necessary 
With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver! 
that their primary mode of transmission is through direct blood-to-blood contact with an infected person. Also, both hepatitis B and C can cause chronic, lifelong infections that can lead to serious liver disease. Hepatitis B is most commonly spread from mother-to-child during birth while hepatitis C is more commonly spread through the use of unclean needles used to inject drugs.
