Clinical and Epidemiologic Features of Viral Hepatitis | |||||
| FEATURE | HAV | HBV | HCV | HDV | HEV |
|---|---|---|---|---|---|
| Incubation (days) | 15-45, mean 30 | 30-180, mean 60-90 | 15-160, mean 50 | 30-180, mean 60-90 | 14-60, mean 40 |
| Onset | Acute | Insidious or acute | Insidious or acute | Insidious or acute | Acute |
| Age preference | Children, young adults | Young adults (sexual and percutaneous), babies, toddlers | Any age, but more common in adults | Any age (similar to HBV) | Epidemic cases: young adults (20-40 years); sporadic cases: older adults (>60) |
Transmission Fecal-oral Percutaneous Perinatal Sexual |
+++ Unusual - ± |
- +++ +++ ++ |
- +++ ±a ±a |
- +++ + ++ |
+++ - - - |
Clinical Severity Fulminant
Progression to chronicity Carrier Cancer Prognosis |
Mild 0.1% None
None None Excellent |
Occasionally severe 0.1-1% Occasional (1-10%) (90% of neonates) 0.1-30%c + (neonatal infection) Worse with age, debility |
Moderate 0.1% Common (85%)
1.5-3.2% + Moderate |
Occasionally severe 5-20%b Commond
Variableg ± Acute, good Chronic, poor |
Mild 1-2%e Nonef
None None Good |
| Prophylaxis | Ig, inactivated vaccine | HBIG, recombinant vaccine | None | HBV vaccine (none for HBV carriers) | Vaccine |
| Therapy | None | Interferon Adefovir Pegylated interferonh Entecavirh Tenofovirh | Pegylated interferon ribavirin telaprevir,i boceprevir,i simeprevir, sofosbuvir, ledipasvir, paritaprevir/ritonavir ombitasvir, dasabuvir daclatasvir, velpatasvir, grazoprevir, elbasvir | Pegylated interferon ± | Nonej |
aPrimarily with HIV co-infection and high-level viremia in index case; more likely in persons with multiple sex partners or sexually transmitted diseases; risk ∼5%.
bUp to 5% in acute HBV/HDV co-infection; up to 20% in HDV superinfection of chronic HBV infection.
cVaries considerably throughout the world and in subpopulations within countries; see text.
dIn acute HBV/HDV co-infection, the frequency of chronicity is the same as that for HBV; in HDV superinfection, chronicity is invariable.
fExcept as observed in immunosuppressed liver allograft recipients or other immunosuppressed hosts.
gCommon in Mediterranean countries; rare in North America and western Europe.
jAnecdotal reports and retrospective studies suggest that pegylated interferon and/or ribavirin are effective in treating chronic hepatitis E, observed in immunocompromised persons; ribavirin monotherapy has been used successfully in acute, severe hepatitis E.
Abbreviation: HBIG, hepatitis B immunoglobulin. See text for other abbreviations.