Published on 13 September 2022

    You’ve heard of hepatitis A, B, C, D and E – so what’s the difference between them? And how do we protect ourselves from this liver infection?

    You’ve probably heard of hepatitis A, B, C, and so on – but what are these, and what’s the difference between them?

    In short, these are liver infections caused by the hepatitis viruses. Among these, hepatitis B infection is most common in Singapore, with about 3.6% of the population being affected. The hepatitis B virus is considered endemic in Singapore and in much of the region.

    TYPE TRANSMISSION SYMPTOMS Hepatitis A Supportive care Eating or drinking contaminated water/foodDirect contact with infected person Causes short term illness VaccinationFood and water hygiene Liver diseaseFeverFatigueAppetite lossJaundice ILLNESS PREVENTION TREATMENT TYPE TRANSMISSION SYMPTOMS Hepatitis B Contact with infected blood/fluidsMother-to-child transmission during birthBlood transfusions Lifetime condition; untreated, can lead to cirrhosis and liver cancer VaccinationSafe sexBlood screening Liver diseaseFeverFatigueAppetite lossJaundice Antiviral medication prevents complications, manages symptoms and reduces complications TYPE TRANSMISSION SYMPTOMS Hepatitis D Contact with infected blood/fluids Chronic infection may progress to cirrhosis Vaccination for Hepatitis B prevents Hepatitis DSafe sexAvoidintravenous drug use Liver diseaseFeverFatigueAppetite lossJaundice ILLNESS PREVENTION TREATMENT Antiviral therapymay be required ILLNESS PREVENTION TREATMENT TYPE TRANSMISSION SYMPTOMS Hepatitis C Intravenous drug useNon-sterile medical equipment Blood transfusions Untreated infection can lead to cirrhosis and liver cancer Only infects those with Hepatitis B Eating or drinking contaminated water/food Supportive care Antiviral therapymay be required for chronic infection in the immunocom-promised TYPE TRANSMISSION SYMPTOMS Hepatitis E Usually cause short term illnessChronic infection may develop in immunocom-promised individuals Food and water hygiene Liver diseaseFeverFatigueAppetite lossJaundice ILLNESS PREVENTION TREATMENT (Enteric hepatitis) Blood screeningAvoid intravenous drug useSterile healthcare environments Liver diseaseFeverFatigueAppetite lossJaundice Safe and effective cure (oral tablets) available ILLNESS PREVENTION TREATMENT

    “The commonest mode of transmission is from mother to child, around the time of birth,” said Dr Daniel Huang, Consultant, Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital (NUH).

    A chronic condition with potentially devastating complications, hepatitis B is not curable, although it can be managed. Dr Huang explained, “Untreated hepatitis B infection causes chronic liver inflammation, which promotes the development of liver cancer and liver hardening (or cirrhosis) over time.”

    In fact, hepatitis B is the commonest cause of liver cancer and liver cirrhosis in Singapore. Such complications can be fatal, and as such, “greater awareness is important to improve early detection and treatment where indicated.”

    In Singapore, most citizens born after 1987 have undergone the national childhood immunisation programme and fortunately have some level of protection against the virus. However, those born prior to that year are susceptible, and should consider screening and vaccination (for most of the population, booster doses aren’t required).

    Regardless of vaccination status, though, it’s important to try to keep hepatitis B at bay. In addition to through childbirth, the virus can also be transmitted through sexual contact or bodily fluids like blood. Some ways to prevent infection include:

    • Avoiding unprotected sex as well as casual sex with multiple sexual partners, as this raises the risk of infection

    • Not sharing needles, razors, toothbrushes, or any sharp objects that may break the skin

    • Ensuring a high level of sanitary practices and hygiene if undergoing body and ear piercing, tattooing, and acupuncture; make sure only disposable or sterilised instruments are used

    Living well with hepatitis B

    The good news: many of the complications from hepatitis B, such as liver cancer and cirrhosis, are entirely preventable with antiviral therapy.

    “Antiviral therapy is safe, effective, and available in a tablet form,” said Dr Huang. “Patients with hepatitis B are advised to [go for] regular follow-ups with the doctor, to assess the need for antiviral treatment.”

    Men above the age of 40 and women over the age of 50 who have hepatitis B should also undergo liver cancer screening with ultrasound scans every six months, he added. This is because NUH research has shown that Asian patients with hepatitis B-related liver cancer tend to undergo treatment less, as compared with non-Asian patients.

    “Therefore, it is important that patients with liver cancer are detected at an earlier stage,” Dr Huang explained. 

    In addition to existing therapies, new developments continue to emerge on the horizon. 

    For instance, a new formulation of the hepatitis B vaccine has just been approved by the FDA. It is more effective than existing vaccines, has a good safety profile, and may benefit older adults with medical conditions, who may not respond well to what is currently on the market.

    The team is also taking steps to move beyond just prevention, and towards curing the disease entirely, said Dr Huang. 

    “New strategies are being developed by our team to cure hepatitis B, so patients in the future may receive a limited duration of curative treatment, rather than long term antiviral therapy,” he said.

    Speak to your doctor to find out more about hepatitis. 

    In consultation with Dr Daniel Huang, Consultant, Division of Gastroenterology & Hepatology, Department of Medicine, NUH.

    Download the full infographics here.

    Related Articles