Differences between Hepatitis A, B, C, D and E

Hepatitis is an inflammation of the liver caused by the virus. There are different strains of hepatitis and the most common ones are A, B, C, D, and E. Hepatitis is a self-limiting condition but can progress to more severe conditions like fibrosis, liver cirrhosis, and liver cancer.

Keep in mind that although hepatitis is mainly caused by viruses, other factors can also lead to hepatitis such as toxic substances like drugs and alcohol and autoimmune response.

Difference between the 5 types of hepatitis

Point of Comparison	Hepatitis A	Hepatitis B	Hepatitis C	Hepatitis D	Hepatitis E
How it is spread	Contaminated food and water/fecal-oral route	Direct contact with infected body fluid including blood	Use of an intravenous drug that is not sterilized/blood	Contact with infected blood/unsafe injections or transfusions	Blood-to-blood contact/childbirth/unprotected sex with infected person/fecal-oral route
Viral genome	RNA	DNA	RNA	RNA	RNA
Classification	Hepatovirus	Hepadnavirus	Hepacivirus	Looks like viroids and plant satellite viruses	Hepevirus
Virus particles expressed in nm and morphology	27 nm /icosahedral non-enveloped	42 nm/double-shelled virion spherical 27 nm/nucleocapsid core 22 nm/spherical and filamentous, has excess virus coat material	About 50 to 80 nm/enveloped	35 to 37 nm/enveloped, a hybrid particle with a coating of HBsAg and HDV core.	32 to 34 nm/non-enveloped icosahedral.
Incubation period	14 to 28 days	30 to 180 days	14 days to 6 months	It needs hepatitis virus B to replicate	14 to 70 days
Nature of infection	Not Chronic	Chronic	Chronic	Chronic	Chronic
Availability of vaccine	Yes	Yes	No	No	Yes
Antigen	HAV	(42 nm – HBsAg, HBcAg, HBeAg), (27 nm – HbcAg, HBeAg), (22 nm – HBsAg)	HCV core antigen	HCV core antigen	HEV antigen
Antibodies	Anti-HAV	(42 nm – Anti-HBs, Anti-HBc), (Anti-HBe, 27 nm – Anti-HBc), (Anti-HBe, 22 nm – Anti-HBs)	Anti-HCV	Anti-HBs, Anti-HDV	Anti-HEV
Symptoms/Clinical manifestations	Fever, headache, general body weakness, and yellowing of the skin (jaundice).	Upon checking on the liver, there’s severe damage along with other chronic diseases.	The symptoms are the same as hepatitis B, but more severe and chronic.	The liver is severely damaged and has a high mortality rate.	Symptoms are mostly evident in pregnant women and have a high mortality rate.
Prevention	Observe proper hygiene Vaccination	Observe proper hygiene Blood screening Vaccination	Proper blood screening Ensuring that sterile needle is used when giving drugs via injection Sanitary healthcare practices	Proper blood screening Ensuring that sterile needle is used when giving drugs through injection	Observe proper hygiene Safe sex should be practiced at all times. Ensure food sanitation
Treatment	There is no available treatment	Nucleotide analogs pegylated interferon	Direct-acting antiviral agent	Interferon	Ribavirin
Complications	The complication is rare but can be extremely fatal. It could lead to cholestasis.	There is a possibility of death due to fulminant hepatitis. The patient will also be at risk for liver	It could lead to liver cirrhosis, liver cancer, and death.	It could lead to serious morbidity and mortality.	The complications are the same as hepatitis A.
Post-exposure management	Two weeks post-exposure; immune globulin should be given to the patient.  It is 80% to 90% effective when given early during the incubation period.	If the patient is not yet immunized, a hepatitis B vaccine must be given including high titer immune globulin to somehow reduce the risk of hepatitis B infection.	Immune globulin can be given, but its effectiveness is unclear.	The primary focus is to make sure that the condition will not lead to hepatitis B.	The available immune globulin does not likely have protective antibodies.
Age preference	Commonly affects children and young adults	Common in young adults, especially those sexually active and percutaneous. It could affect babies and toddlers too.	It could affect people of all ages, but more common in adults.	It could affect people of all ages.	For epidemic cases, the ones affected are young and adults, particularly people in their 20s to 40s. For sporadic cases, the ones severely affected are older adults, specifically, 60 years old and above.
Onset	Acute/Sudden	Acute/Insidious	Acute/Insidious	Acute/Insidious	Acute
Severity	Mild	Can be severe	Moderate	Can be severe	Mild
Therapy	No available therapy	Interferon Adefovir Lamivudine Entecavir Pegylated interferon Tenofovir Telbivudine	Pegylated interferon Telaprevir Ribavirin Paritraprevir	Pegylated interferon	None
Prognosis	Generally good. With treatment and timely management, the patient will have a full recovery.	Generally good. The patient will recover fully but will be a chronic carrier.	There is a high rate of chronic carriers, but the majority recovers fully.	The infection is acute and short-lived but can become chronic too. If a patient is a chronic hepatitis B carrier and experienced sudden exacerbation, then a hepatitis D is suspected.	Generally good. The patient fully recovers with no chronic carrier.

What to keep in mind

• The outcome is determined by many factors such as the type of hepatitis a person has, the clinical manifestations, especially how soon the symptoms developed and noticed, and timely treatment.
• Some people don’t even know they have hepatitis until dreadful symptoms start to appear such as liver failure.
• Hepatitis A usually resolved within 2 months and no long-term effects can be experienced. In fact, the patient will have a lifelong immunity after recovering from it.
• With hepatitis B, the majority of adults recover within the 90-day period and they have lifelong immunity too.
• The problem is with infants and older children as most of them develop chronic infections leading to severe complications like liver cirrhosis and liver cancer.
• More so, the majority of hepatitis C leads to a chronic condition, with at least 5% of people who have it will experience life-threatening complications.

References

1. https://www.southernnevadahealthdistrict.org/
2. https://www.medicinenet.com/
3. https://www.cdc.gov/hepatitis/
4. https://www.verywellhealth.com/
5. https://my.clevelandclinic.org/
6. https://www.health.com/condition/hepatitis-c/types-of-hepatitis
7. https://www.hepmag.com/blog/different-types-hepatitis
8. https://www.usatoday.com/
9. https://www.sahealth.sa.gov.au/
10. https://www.everydayhealth.com/sexual-health/hepatitis.aspx