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U-M COVID-19 Response

University Health Service

Viral Hepatitis and Hepatitis A Outbreak

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Southeast Michigan is experiencing an outbreak of hepatitis A. Information about this outbreak is at the Michigan Department of Health and Human Services website. Vaccination is recommended to prevent hepatitis A.

if you are concerned about symptoms or risk for viral hepatitis, and you are a U-M student or other UHS patient, you may call for Nurse Advice by Phone. 

How to get immunized: 

Immunization is an effective means to prevent hepatitis A and B. See Immunizations for details.

On this page:

What is viral hepatitis?

Viral hepatitis is an infection of the liver caused by a virus that attacks liver cells. The resulting inflammation may impair the liver's ability to aid in digestion of food and to remove toxins from the blood. Symptoms range from mild to severe, but some individuals have no symptoms. Infrequently, acute infections can be fatal.

There are several types of viral hepatitis, called A, B, C, D, E, F and G. Of all types of hepatitis, A, B and C are the most common in the US and so will be described below.

Hepatitis A:

Hepatitis A (formerly called infectious hepatitis) is caused by the hepatitis A virus (HAV). Hepatitis A is more common in developing countries than in the US, although hepatitis A is increasing in the US, including in southeast Michigan.

Transmission is through food or water that is contaminated with feces, through anal/oral contact, and rarely through blood.

Symptoms: Some people with hepatitis A have no noticeable symptoms. Onset is usually abrupt with fever, tiredness, lack of appetite, nausea, abdominal discomfort and diarrhea, followed within a few days by jaundice (which results in a yellow appearance of skin and eyes). Symptoms can vary from a mild illness lasting a few weeks to (rarely) a disabling disease lasting several months. Complete recovery, without chronic liver disease, is usual. Incubation period is 15-50 days, averaging 28-30 days.

Diagnosis: A blood test is available, but it is not useful unless initial symptoms develop.

Treatment: There is no treatment for hepatitis A. In 99% of reported cases, the infection will clear up over a period of a few weeks to months.

Prevention: Vaccination is recommended for groups listed on the CDC website. In addition, UHS strongly recommends that U-M food workers and U-M students be vaccinated. In the US, hepatitis A became a routine childhood vaccination in 2006, so many students have already been vaccinated. 

Hepatitis A vaccination usually is given in two doses, 6 months apart. If the vaccine is given in two doses, travelers may receive the second dose 4-6 weeks before departure.) See also Immunizations.

An injection of immune globulin within 2 weeks of known exposure reduces risk of developing the disease.

Also, avoid contaminated water and food, practice good hygiene, and avoid oral-anal contact during sex.

Hepatitis B:

Hepatitis B is caused by the hepatitis B virus (HBV).

Transmission is through blood and other body fluids contaminated with blood. All individuals who are chronically infected may be able to transmit it. Routes of transmission include:

  • Sexual contact including vaginal intercourse, anal intercourse (more likely because of greater tearing of tissues) and oral sex
  • Exposure to infected blood that comes into contact with cuts, open sores or mucous membranes
  • Sharing unsterilized needles and other equipment while injecting substances such as heroin, cocaine, steroids, etc.
  • Piercing the skin with unsterilized instruments such as those used in tattooing, body piercing, electrolysis or acupuncture
  • Sharing personal hygiene items such as razors or toothbrushes
  • From mother to newborn baby

Symptoms: Many people have no noticeable symptoms. Symptoms may develop slowly and include lack of appetite, abdominal discomfort, nausea and vomiting, sometimes joint pain and rash, often progressing to jaundice (which results in a yellow appearance of the skin and eyes). Fever may be absent or mild. Incubation period is 45-180 days, rarely as long as 9 months, averaging 60-90 days.

Approximately 2-10% of adults and 25-80% of children under the age of 5 will not be able to clear the virus in six months following infection and are considered to be chronically infected. Long term, chronic hepatitis B can cause liver cell damage, leading to cirrhosis and cancer.

Diagnosis: A blood test is available.

Treatment: Antiviral drugs are occasionally used for chronic infections. New treatments show promise.

Prevention: A vaccine is available for people of any age and especially recommended for:

  • Babies at birth
  • Children 0-18 who have not been vaccinated
  • People with occupational risk, e.g. healthcare and public safety workers
  • Childcare workers and teachers
  • People traveling to high risk countries for more than 6 months
  • Household contacts and sex partners of HBV carriers
  • People who have intimate and/or sexual contact with chronic carriers of hepatitis B
  • Men who have sex with men
  • People who have kidney disease, HIV, chronic liver disease, or diabetes

The vaccine consists of 2-4 doses, depending on the schedule. Also a specially prepared injection of immune globulin within 2 weeks of known exposure reduces risk of transmission. See also Immunizations.

Also:

  • Abstain from sex or practice safer sex, including using latex or polyurethane condoms.
  • If you use injection drugs, do not share equipment. See also Strategies for Disease Prevention from the CDC.
  • Treat all body fluids as if potentially infectious and protect yourself accordingly.
  • Choose a reputable business for tattoos and piercings; inquire about sterilization techniques.
  • Do not share personal hygiene items such as razors and toothbrushes.

Hepatitis C:

Hepatitis C is caused by the hepatitis C virus (HCV).

Transmission is primarily through infected blood or blood products. The primary current route of transmission is injection drug use. It is not easily transmitted through sex. In about 10-20% of cases, transmission route has not been identified.

Symptoms: 70-75% of people have no noticeable symptoms. Symptoms may develop gradually with loss of appetite, fatigue, abdominal discomfort, nausea and vomiting, and sometimes progressing to jaundice (which results in a yellow appearance of skin and eyes). Incubation period ranges from 2 weeks to 6 months, averaging 6-9 weeks.

Up to 85% of people with hepatitis C develop chronic infection, which is often asymptomatic. Some develop cirrhosis (scarring of the liver). Chronic hepatitis C infection also substantially increases risk for liver cancer.

Diagnosis: A blood test is available. Tests for hepatitis C typically become positive within 6 months after infection occurs. You may be at risk for hepatitis C and should contact your health care provider for a blood test if you:

  • Were notified that you received blood from a donor who later tested positive for hepatitis C
  • Have ever injected illegal drugs, even if you experimented a few times many years ago
  • Received a blood transfusion or solid organ transplant before July, 1992
  • Received a blood product for clotting problems produced before 1987
  • Have ever been on long-term kidney dialysis
  • Have evidence of liver disease
  • Are a health care or public safety worker who has been exposed to infected blood

Treatment: Eradication of the virus may be possible with drug therapy. 

Prevention: No vaccine is available. Prevention methods include:

  • Abstain from sex or practice safer sex, including using latex or polyurethane condoms.
  • Do not share injection drug equipment.
  • Treat all body fluids as if potentially infectious and protect yourself accordingly.
  • Choose a reputable business for tattoos and piercing; inquire about sterilization techniques.
  • Do not share personal hygiene items such as razors and toothbrushes.

More information:

Image on this page is “DSCF0664” by benandbarnet is licensed under CC BY 2.0.