What’s Worse, Hepatitis A, B, or C?

Medically Reviewed on 9/29/2021
what's worse, hepatitis A, B, or C
Because there is no vaccination available against hepatitis C, hepatitis C is often considered worse than hepatitis A or B

Because there is no vaccination available against hepatitis C, hepatitis C is often considered the worst hepatitis

Hepatitis A is not a chronic infection, whereas hepatitis B and C can and do cause chronic infections. There are vaccines to prevent hepatitis A and B but none for hepatitis C, which makes it more lethal than hepatitis A and B. 

According to studies, up to 70% of people who are infected with hepatitis C develop chronic liver disease, and up to 20% of people develop cirrhosis. According to the CDC, up to 5% of people with hepatitis C may die from cirrhosis or liver cancer. The risk of chronic infections is high if infections occur at a young age.

Viral hepatitis is the leading cause of hepatitis in the United States, with the most common culprits being hepatitis B and C viruses, which are transmitted through blood and body fluids. Hepatitis B and C viruses do not always cause symptoms, but if left untreated, they can have serious long-term consequences.

Hepatitis A, B, and C: what’s the difference?

Hepatitis (inflammation of the liver) is often caused by a virus that comes in different strains. The most common strains of hepatitis are hepatitis A, B, and C. They all are contagious, but they differ primarily by the way they are spread.

Table: Differences among hepatitis A, B, and C

Table: Differences among hepatitis A, B, and C
Factors Hepatitis A Hepatitis B Hepatitis C
Symptoms
  • Fatigue/tiredness
  • Fever
  • Yellow skin or eyes
  • Loss of appetite
  • Dark urine
  • Light-colored stools
  • Nausea
  • Stomach pain
  • Diarrhea
  • Fatigue/tiredness
  • Fever
  • Yellow skin or eyes
  • Loss of appetite
  • Dark urine
  • Light-colored stools
  • Nausea
  • Stomach pain
  • Vomiting
  • Joint pain
  • Fatigue/tiredness
  • Fever
  • Yellow skin or eyes
  • Loss of appetite
  • Dark urine
  • Light-colored stools
  • Nausea
  • Stomach pain
  • Vomiting
Causes
  • Exposure to feces of someone with hepatitis A
  • Infected food and water
  • Caused by hepatitis A virus
  • Exposure to blood, semen, or vaginal fluids of someone with hepatitis B
  • Can be passed from mother to baby at birth
  • Caused by hepatitis B virus (HBV)
  • Exposure to blood of someone with hepatitis C
  • Can be passed from mother to baby at birth, although rare
  • Caused by hepatitis C virus (HCV)
Incubation period 15-50 days (average 28 days) 45-160 days (average 90 days) 14-180 days (average 45 days)
Risk population
  • People who share a bathroom or kitchen with someone with hepatitis A
  • People who live or travel to areas where hepatitis A is common
  • People who have sex with someone with hepatitis A
  • People who work or attend daycare or other places where people need diapers or help with toileting
  • People who share or work with needles for injecting drugs, tattooing, or piercing
  • People who have sex with someone with Hepatitis B
  • People who may be exposed to blood or bodily fluids on the job
  • People who share or handle razors, toothbrushes, or other personal care items with someone with hepatitis B
  • People who share or work with needles for injecting drugs, tattooing, or piercing
  • People who have sex with someone with hepatitis C
  • People who may have received blood, blood products, or an organ transplant before 1992
Vaccinations
  • Yes
  • May be given at one year of age or after
  • Yes
  • Should be started at birth
  • Everyone from birth to 18 years of age should be vaccinated
  • Babies born to mothers with hepatitis B should get the vaccine within 12 hours
No vaccination available; however, research is positive in this aspect
Treatment
  • No treatment required
  • May go away by itself within 2-6 months
Treatment is available Treatment is available
Post diagnosis
  • Rest
  • Don’t drink alcohol
  • Only take doctor-approved medicines
  • Eat healthy
  • Get regular check-ups
  • Get hepatitis A vaccine
  • Don’t donate blood, organs, or tissue
  • Rest
  • Don’t drink alcohol
  • Only take doctor-approved medicines
  • Eat healthy 
  • Get regular check-ups
  • Get hepatitis A and B vaccines
  • Don’t donate blood, organs, or tissue
  • Rest
  • Don’t drink alcohol
  • Only take doctor-approved medicines
  • Eat healthy 
  • Get regular check-ups
  • Get hepatitis A and B vaccines
  • Don’t donate blood, organs, or tissue
Severity Rarely severe
  • Chronic
  • In the United States, about 2,000 people die each year from hepatitis B
  • Death from chronic liver disease occurs in 15%-25% of chronically infected people
  • People who have chronic HBV infection have a much higher risk of liver failure and liver cancer
  • Can be deadly
  • In the United States, about 20,000 people die each year from HCV. People who have chronic HCV infection have a much higher risk of liver failure and liver cancer
  • Chronic HCV-related liver disease is the leading cause for liver transplant

SLIDESHOW

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Is there a possibility of coinfection?

Both hepatitis B and C can be present at the same time. Hepatitis C may become more dominant, reducing hepatitis B levels in the bloodstream to low or undetectable levels. 

Prior to starting hepatitis C treatment, people should have their blood tested for hepatitis B using the three-part blood test (HBsAg, anti-HBc total, and anti-HBs). According to the American Association for the Study of Liver Diseases treatment guidelines, people who are currently infected with hepatitis B (HBsAg positive) or who have recovered from a previous infection (HBsAg negative and anti-HBc positive) should be managed carefully to avoid dangerous elevations in liver enzymes that can lead to liver failure.

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Medically Reviewed on 9/29/2021
References
What’s the Difference: Hepatitis B vs Hepatitis C? https://www.hepb.org/blog/whats-the-difference-hepatitis-b-vs-hepatitis-c/#:

What are the Difference between Hepatitis A, B and C? https://healthtalk.unchealthcare.org/whats-the-difference-between-hepatitis-a-b-and-c/

The ABCs of Hepatitis – for Health Professionals: https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf