Most people associate serious liver disease with excessive alcohol consumption, unhealthy lifestyles or long-term medical conditions. However, two viruses can attack the liver without producing any obvious warning signs, and one of them is responsible for an estimated 1.1 million deaths annually.
According to the World Health Organization's Global Hepatitis Report 2026, approximately 240 million people were living with chronic hepatitis B in 2024. Around 900,000 new chronic infections occurred that year, while an estimated 1.1 million people died from complications associated with the disease.
Perhaps even more concerning, only 27% of people living with chronic hepatitis B had been diagnosed, and just 4.3% were receiving antiviral treatment.
Hepatitis A presents a different danger. Although it does not cause chronic infection, it can trigger sudden outbreaks through contaminated food, drinking water or close contact. In its July 2026 hepatitis A factsheet, WHO estimated that the disease caused 35,569 deaths worldwide in 2023.
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Both infections can begin with nausea, tiredness and abdominal discomfort. Yet their transmission routes, long-term consequences and available treatments differ considerably.
Understanding these differences can help explain who is most vulnerable, where the diseases are spreading and why vaccination and early diagnosis remain so important.
What is the difference between hepatitis A and hepatitis B?
Hepatitis is the medical term for inflammation of the liver. Although inflammation can result from alcohol, certain medications, autoimmune disorders and other medical conditions, viral hepatitis occurs when an infection causes inflammation and damage to liver tissue.
Five principal hepatitis viruses are recognised: A, B, C, D and E. Each has different characteristics, transmission routes and potential consequences. Hepatitis A and B are particularly important because both can cause significant illness, but they behave very differently once they enter the body.
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Hepatitis A is caused by the hepatitis A virus, or HAV. It typically produces an acute infection, meaning the illness develops over a relatively short period before the body clears the virus. Most patients recover completely, and a previous infection generally provides lifelong immunity.
Hepatitis B is caused by the hepatitis B virus, or HBV. Some patients develop an acute infection and subsequently recover, but others develop chronic hepatitis B, in which the virus remains in the body for longer than six months.
A chronic infection can persist for decades and may eventually cause severe liver scarring, liver failure or cancer. This long-term risk is the principal reason hepatitis B accounts for a much greater global mortality burden than hepatitis A.
How do people become infected with hepatitis A?
Hepatitis A is primarily transmitted through the faecal-oral route. This means the virus enters a person's mouth after food, water, hands or another surface has been contaminated with microscopic amounts of faecal material from someone carrying the infection.
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Contamination can occur when an infected person prepares food without washing their hands properly after using the toilet. The virus may also spread through drinking water contaminated with sewage, eating inadequately cooked shellfish harvested from polluted waters or consuming contaminated food products.
According to the CDC's 2026 Yellow Book guidance on hepatitis A, outbreaks have been linked to contaminated seafood, frozen berries, fresh produce and other foods. The virus can survive freezing and remain infectious under environmental conditions that would kill many other pathogens.
Person-to-person transmission is another important route. Household members, caregivers and sexual partners can become infected through close contact when appropriate hygiene precautions are not followed. Sexual activities involving oral-anal contact can also transmit the virus.
Hepatitis A does not ordinarily spread through breathing the same air as an infected person, coughing or casual everyday contact. The principal concern is accidentally ingesting the virus, which makes effective sanitation and hand hygiene particularly important.
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Hepatitis B spreads in a completely different way
Unlike hepatitis A, hepatitis B is primarily transmitted through infected blood, semen and certain other bodily fluids. Infection can occur when these fluids enter another person's bloodstream or come into contact with susceptible mucous membranes.
Sexual intercourse without appropriate protection is one possible route, particularly when someone has not been vaccinated against hepatitis B. Sharing contaminated needles, syringes or other injecting equipment creates another significant risk because even very small quantities of infected blood can transmit the virus.
Transmission can also occur through improperly sterilised medical instruments, tattooing equipment, piercing tools or sharp personal items such as razors. Healthcare workers may be exposed through accidental needlestick injuries or other contact with infected blood.
According to the WHO's July 2026 hepatitis B factsheet, transmission from an infected mother to her child during childbirth remains a major contributor to the global burden of chronic hepatitis B.
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Hepatitis B does not spread through contaminated drinking water or food. Ordinary activities such as hugging, shaking hands, sharing a workplace, coughing or eating a meal with someone who has hepatitis B do not transmit the infection.
This distinction is important because people living with chronic hepatitis B sometimes experience unnecessary stigma despite posing no risk through normal social contact.
Can someone spread hepatitis without knowing they are infected?
Yes, and this is one of the most important features of both diseases. A person with hepatitis A may become infectious before developing symptoms, while someone with chronic hepatitis B can remain infected and potentially transmit the virus for years without realising it.
The CDC's surveillance guidance on hepatitis A explains that infected individuals can release substantial quantities of the virus in their stool before they experience obvious illness. The period of greatest infectiousness generally occurs during the two weeks before symptoms such as jaundice appear.
This creates opportunities for transmission through food preparation, household contact or other exposures before anyone recognises that an infection is present.
Hepatitis B can remain even more difficult to detect. Many newly infected people have no noticeable symptoms, and chronic infection may cause little discomfort until serious liver damage has already developed.
People with chronic hepatitis B may therefore unknowingly carry the virus for years, sometimes decades, while the infection continues to affect their liver.
What are the first symptoms of hepatitis A and B?
The early symptoms of hepatitis A and hepatitis B can be remarkably similar. Both infections may cause fatigue, loss of appetite, nausea, vomiting, abdominal discomfort, fever and general weakness.
Some patients experience pain or tenderness in the upper-right part of the abdomen, where the liver is located. Others develop dark urine, pale-coloured stools or jaundice, a condition in which the skin and whites of the eyes become yellow because bilirubin builds up in the bloodstream.
The timing of symptoms differs. Hepatitis A has an average incubation period of approximately 28 days, although symptoms can appear between 15 and 50 days after exposure. Hepatitis B generally has a longer incubation period, with symptomatic illness often emerging around 90 days after infection.
According to the CDC's clinical information on hepatitis B symptoms, symptoms of acute hepatitis B can appear between approximately 60 and 150 days after exposure.
However, not everyone experiences noticeable illness. Young children infected with hepatitis A often have few or no symptoms, while adults are more likely to develop jaundice and other recognisable signs.
Hepatitis B frequently causes no symptoms at all, particularly among infected infants and young children. This means that an absence of fever, abdominal pain or jaundice does not reliably exclude either infection.
What happens inside the liver during hepatitis?
The liver performs hundreds of essential functions, including processing nutrients, producing proteins required for blood clotting, regulating blood chemistry and breaking down certain medications and harmful substances.
When hepatitis viruses infect the liver, they trigger inflammation that can interfere with these processes. Liver cells may become damaged, and blood tests can reveal elevated levels of enzymes associated with liver injury.
In hepatitis A, the immune system typically eliminates the virus after an acute period of inflammation. Most patients recover without permanent liver damage, although symptoms may persist for weeks or occasionally several months.
Hepatitis B can follow a more dangerous course when the immune system fails to clear the infection. Chronic inflammation can gradually lead to fibrosis, a process in which scar tissue replaces healthy liver tissue.
Over time, extensive fibrosis can develop into cirrhosis. Severe cirrhosis interferes with normal liver function and can cause fluid accumulation, internal bleeding, confusion, jaundice and ultimately liver failure.
Chronic hepatitis B also increases the risk of hepatocellular carcinoma, the most common form of primary liver cancer. Importantly, liver cancer can sometimes develop in people with chronic hepatitis B even before cirrhosis has occurred.
Why hepatitis B can become dangerous decades later
One of the most unusual features of hepatitis B is that the age at which someone becomes infected strongly influences the likelihood of developing chronic disease.
According to the CDC's clinical overview of hepatitis B, approximately 90% of infants infected around birth develop chronic hepatitis B. Among children infected between one and five years of age, the proportion is approximately 30%.
Adults generally have a much stronger ability to clear a new hepatitis B infection. Approximately 95% of immunocompetent adults recover from acute hepatitis B without developing chronic infection.
This difference helps explain why hepatitis B remains particularly widespread in countries where transmission during childbirth or early childhood has historically been common.
A baby infected during delivery may appear completely healthy for many years. However, without diagnosis, monitoring and appropriate treatment, the infection can remain active long enough to cause significant liver damage later in adulthood.
Not everyone with chronic hepatitis B develops cirrhosis or liver cancer. Nevertheless, the possibility of these complications means that people with chronic infection require appropriate long-term medical assessment, even when they feel healthy.
Who is most likely to become infected with hepatitis A?
Anyone who has not been vaccinated or previously infected can contract hepatitis A. However, exposure is more common in environments where sanitation, food safety and access to clean drinking water are inadequate.
People travelling to countries with substantial hepatitis A transmission may face an increased risk, particularly when consuming food or water prepared under conditions where contamination is possible.
Household members and sexual partners of an infected person are also at increased risk. Certain communities may experience outbreaks when crowded living conditions, shared sanitation facilities or limited access to healthcare make it difficult to prevent transmission.
According to the WHO's hepatitis A risk assessment, increased exposure has been identified among people who use drugs, men who have sex with men and people experiencing homelessness.
These risks are associated with circumstances that facilitate viral transmission, rather than with any inherent susceptibility linked to personal identity.
Young children can also play an important role in transmission because they frequently develop infections without obvious symptoms. Adults who have never been infected or vaccinated may subsequently develop more severe illness after exposure.
Who faces the greatest danger from hepatitis A?
Most people infected with hepatitis A recover completely, but the risk of severe complications increases with age and underlying health problems.
Older adults are more likely than young children to develop symptomatic illness, and the risk of a fatal outcome is considerably greater in older age groups. People who already have chronic liver disease may also be less able to withstand additional liver inflammation.
Patients with cirrhosis, chronic hepatitis B or hepatitis C can experience more severe consequences if they contract hepatitis A. People with weakened immune systems may also require careful assessment, particularly when determining appropriate preventive treatment after exposure.
A small proportion of patients develop acute liver failure, sometimes described as fulminant hepatitis. This complication occurs when liver function deteriorates rapidly, potentially causing severe clotting problems, neurological symptoms and failure of other organs.
Acute liver failure is a medical emergency. Patients may require intensive care, and in the most severe cases, liver transplantation may be considered.
Which groups face the greatest risk from hepatitis B?
The risk of hepatitis B infection depends on exposure to infected blood or bodily fluids and whether a person has effective vaccine protection.
People who have sexual contact with an infected partner, individuals who share injecting equipment and healthcare workers exposed to contaminated needles or blood are among the groups with potentially increased exposure.
Individuals receiving medical treatment in settings where sterilisation procedures are inadequate may also face greater risks. The same applies to people undergoing tattooing or piercing when equipment is not properly sterilised.
Babies born to mothers with hepatitis B require particular attention because infection acquired during childbirth carries such a high risk of becoming chronic.
People living with HIV or other conditions affecting immune function may require additional medical assessment. Those who already have chronic hepatitis B may also face greater long-term complications if they are infected with hepatitis D, a separate virus that can replicate only in the presence of hepatitis B.
The WHO's updated hepatitis D factsheet estimates that approximately 12 million people worldwide have chronic hepatitis D alongside hepatitis B, with coinfection associated with faster progression towards serious liver disease.
Where in the world is hepatitis A most common?
Hepatitis A occurs worldwide, but infection patterns vary considerably between countries. The strongest association is with sanitation and access to safe drinking water rather than climate alone.
According to the CDC's 2026 travel guidance, hepatitis A has traditionally been highly endemic in parts of Africa and Asia, with intermediate levels of transmission in parts of Central and South America, eastern Europe and Asia.
Countries and regions where sanitation and water infrastructure are less reliable may experience repeated transmission, particularly among children. In some highly endemic communities, most people acquire immunity during childhood, often without experiencing noticeable illness.
Paradoxically, improvements in sanitation can sometimes change the age distribution of infection. When fewer children are exposed, more people reach adolescence or adulthood without immunity, potentially increasing the number of symptomatic cases during subsequent outbreaks.
Western Europe and the United States generally have much lower background transmission rates, largely because of improved sanitation, food safety and vaccination. Nevertheless, outbreaks can still emerge through imported food products, local person-to-person transmission or exposure during international travel.
A major hepatitis A outbreak recently affected Europe
The threat posed by hepatitis A became particularly visible during 2025, when a substantial outbreak affected several European countries.
According to the European Union Drugs Agency's European Drug Report 2026, more than 6,500 hepatitis A cases were reported across Czechia, Slovakia, Hungary and Austria during 2025.
Slovakia recorded 2,482 cases, Czechia reported 2,310, Hungary registered 1,548 and Austria reported 216. Across the outbreak, 39 deaths were recorded.
The outbreak disproportionately affected people experiencing homelessness, people who use drugs and communities living in conditions where sanitation and healthcare access were limited.
Hospitalisation rates were particularly high among reported cases. Depending on the country and availability of data, between 41% and 80% of identified patients required hospital treatment. These figures describe the affected outbreak populations and should not be interpreted as the general probability of hospitalisation after every hepatitis A infection.
The outbreak peaked during 2025, and European public health authorities reviewed the response during 2026 to identify ways of improving vaccination access, hygiene interventions and early detection.
Hepatitis A has also caused infections in the United States
Although hepatitis A is less common in the United States than in many lower-income regions, foodborne outbreaks remain possible.
On October 2, 2026, the CDC published the final findings of a multistate hepatitis A investigation involving 37 identified illnesses across four states. Thirty patients were hospitalised, and no deaths were reported.
The investigation examined a possible connection with frozen clams and the consumption of raw or undercooked shellfish. Although investigators identified a strong association with certain food exposures, the source was described as potentially linked rather than conclusively established.
Reported illnesses began between July 2025 and June 2026, and the investigation was closed on October 1, 2026.
The outbreak demonstrates why hepatitis A remains a food safety concern even in countries with modern sanitation infrastructure. Contaminated products can expose people who have never travelled abroad or knowingly encountered someone carrying the virus.
Which countries have the greatest burden of hepatitis B?
Hepatitis B affects populations across the world, but the burden is particularly high in the Western Pacific, sub-Saharan Africa and parts of South and Southeast Asia.
According to the WHO's July 2026 global hepatitis B figures, approximately 102 million people in the Western Pacific Region were living with chronic hepatitis B in 2024. Countries in this region include China, Vietnam, the Philippines and several Pacific island nations.
The WHO African Region accounted for approximately 64 million chronic infections, with substantial disease burdens across countries such as Nigeria, Ethiopia and the Democratic Republic of the Congo.
Another 43 million people were estimated to be living with chronic hepatitis B in the WHO South-East Asia Region, which includes countries such as India, Indonesia, Bangladesh and Thailand.
The Eastern Mediterranean Region accounted for approximately 16 million infections, while the WHO European Region had 9.7 million and the Region of the Americas approximately 5 million.
These regional figures describe total estimated infections, not individual country prevalence rankings. They are strongly influenced by population size as well as infection rates.
The burden of new infections is particularly concerning in Africa. WHO estimates that 68% of new chronic hepatitis B infections in 2024 occurred in its African Region, reflecting major gaps in timely vaccination and prevention of mother-to-child transmission.
How deadly is hepatitis A?
Hepatitis A is generally less likely to cause death than chronic hepatitis B, but it should not be dismissed as harmless.
The majority of infected people recover completely, often without permanent liver damage. However, adults are more likely than children to develop significant symptoms, and the risk of death rises with age and existing liver disease.
According to WHO estimates published in July 2026, hepatitis A was responsible for approximately 35,569 deaths worldwide in 2023. These deaths were primarily associated with severe acute liver injury and complications of liver failure.
There is no single global fatality percentage that applies equally to every patient. Risk depends on age, pre-existing health conditions, the severity of liver inflammation and access to appropriate medical care.
In particular, mortality figures from hospitalised patients or severe outbreaks cannot reliably be applied to the general population because many mild or symptom-free infections are never diagnosed.
The most important distinction is that hepatitis A does not normally remain in the body permanently. Once a patient has recovered, they generally develop lifelong protection against reinfection with hepatitis A.
How deadly is hepatitis B?
Hepatitis B has a fundamentally different mortality pattern because the greatest danger often develops years or decades after the original infection.
Many patients survive the acute illness without complications, and most adults clear the virus completely. However, people who develop chronic hepatitis B face an increased lifetime risk of cirrhosis, liver failure and liver cancer.
The WHO's 2026 Global Hepatitis Report estimates that chronic hepatitis B caused approximately 1.1 million deaths in 2024, primarily through cirrhosis and hepatocellular carcinoma.
The organisation also reported that hepatitis B-related deaths had increased by approximately 17% since 2015, despite progress in reducing new infections through vaccination programmes.
These figures should not be interpreted as meaning that most people with hepatitis B will die from the infection. Many individuals live for decades with chronic hepatitis B, particularly when they receive appropriate monitoring and treatment.
A single fatality percentage is difficult to calculate because outcomes depend on age at infection, the presence of cirrhosis, viral activity, other medical conditions and whether treatment is available.
The estimates for hepatitis A and B also refer to different years and estimation methods: 2023 for hepatitis A and 2024 for hepatitis B. They demonstrate the different scale of their mortality burdens rather than providing a direct case-fatality comparison.
How do doctors diagnose hepatitis A and B?
Because hepatitis A and B can produce similar symptoms, doctors cannot reliably distinguish between them through clinical examination alone.
Blood tests play a central role. For hepatitis A, clinicians commonly look for immunoglobulin M antibodies against the hepatitis A virus, known as anti-HAV IgM, which can indicate a recent infection. In some circumstances, molecular tests may detect viral genetic material.
Hepatitis B requires a different group of blood tests. The commonly recommended initial screening panel includes hepatitis B surface antigen, antibodies against the surface antigen and antibodies against the core antigen.
According to the CDC's hepatitis B screening guidance, these results help doctors determine whether someone currently has hepatitis B, has recovered from a previous infection, has vaccine-induced immunity or remains susceptible to infection.
Additional tests can measure the amount of hepatitis B virus in the blood, evaluate liver inflammation and assess whether scarring or other complications have developed.
For chronic hepatitis B, doctors may also use ultrasound examinations and liver stiffness measurements to monitor liver health and determine whether treatment or surveillance for liver cancer is needed.
Is there a cure for hepatitis A?
There is no specific antiviral medicine routinely used to eliminate hepatitis A. However, most infections resolve naturally as the immune system clears the virus.
Treatment focuses on supporting the body during recovery. This usually involves rest, maintaining adequate hydration, eating appropriately and managing symptoms such as nausea or vomiting.
According to the CDC's clinical treatment guidance for hepatitis A, symptoms generally resolve within two months, although some patients experience prolonged or recurring illness for up to six months.
People with hepatitis A should avoid alcohol and seek medical advice before taking medications or supplements that may place additional stress on the liver. Severe infections can require hospitalisation, particularly when dehydration, clotting abnormalities or signs of liver failure develop.
In rare cases involving irreversible acute liver failure, transplantation may be the only lifesaving option. Nevertheless, complete recovery remains the expected outcome for the overwhelming majority of patients.
Can chronic hepatitis B be cured?
Unlike hepatitis A, chronic hepatitis B usually cannot be completely eliminated with currently available routine antiviral treatment. However, effective medicines can suppress viral activity and substantially reduce the risk of long-term complications.
The principal medications recommended internationally include tenofovir and entecavir. These drugs interfere with viral replication, allowing doctors to reduce the amount of hepatitis B virus circulating in the body.
Effective treatment can slow or prevent the progression of liver scarring, lower the risk of liver cancer and improve long-term survival. However, patients often need to continue therapy for many years or throughout their lifetime because the virus can persist in infected liver cells.
Not every patient with chronic hepatitis B immediately requires antiviral medication. Treatment decisions depend on factors such as viral load, liver inflammation, the presence of fibrosis or cirrhosis, age, other medical conditions and clinical guidelines.
According to the WHO's 2026 assessment of global treatment coverage, approximately 10 million people were receiving hepatitis B treatment in 2024, representing just 4.3% of those living with chronic infection.
This treatment gap remains one of the largest obstacles to reducing hepatitis B mortality. Effective medicines already exist, but many people do not know they are infected, cannot access appropriate testing or face financial and healthcare barriers to treatment.
Can vaccination prevent hepatitis A and B?
Vaccination is one of the most effective methods of preventing both infections, although vaccine schedules and eligibility differ.
Hepatitis A vaccines are highly effective and generally provide long-lasting protection. In many countries, the standard vaccination series involves two doses administered at least six months apart.
Vaccination may be recommended for travellers visiting countries where hepatitis A is common, people with chronic liver disease and individuals with a higher likelihood of exposure.
Hepatitis B vaccination is particularly important because preventing an infection during infancy can eliminate the risk of developing chronic hepatitis B from that exposure.
WHO recommends that all newborns receive a hepatitis B vaccine dose within 24 hours of birth, followed by additional doses according to the national immunisation schedule. Protection after a completed vaccination series is long-lasting, and routine booster doses are generally unnecessary for immunocompetent people who respond to vaccination.
National recommendations can differ. In December 2025, for example, the CDC updated its US hepatitis B birth-dose recommendation to support individual decision-making when the mother tests negative, while maintaining prompt vaccination for babies whose mothers test positive or have unknown infection status.
For babies born to mothers with hepatitis B, additional measures are important. These may include administering hepatitis B immune globulin alongside vaccination shortly after birth, and antiviral treatment during pregnancy for mothers with high viral loads.
A combined vaccine protecting against both hepatitis A and B is also available in some countries, making it possible for eligible individuals to obtain protection against both infections through one vaccination programme.
What should someone do after possible exposure?
A suspected exposure to hepatitis A or B should be taken seriously even when the person feels completely healthy. Preventive treatment may still be possible before symptoms develop.
For hepatitis A, post-exposure vaccination can prevent illness when administered promptly, ideally within 14 days of exposure. Depending on age, immune status and underlying medical conditions, clinicians may also recommend immune globulin to provide immediate short-term protection.
For hepatitis B, urgent medical assessment is important following exposure to infected blood, an accidental needlestick injury, sexual contact with an infected person or another event involving possible transmission.
People who have not been vaccinated or whose immune status is uncertain may require hepatitis B vaccination and, in some circumstances, hepatitis B immune globulin. The appropriate approach depends on the exposure, the source person's infection status and the individual's previous vaccination history.
People who develop jaundice, dark urine, significant abdominal discomfort, severe vomiting or unexplained fatigue should seek medical evaluation, particularly if they have recently travelled, experienced possible blood exposure or had contact with someone diagnosed with hepatitis.
Symptoms such as confusion, unusual bleeding, extreme drowsiness or rapidly worsening jaundice may indicate severe liver dysfunction and require emergency medical attention.
How can people reduce their risk of infection?
Preventing hepatitis A primarily involves vaccination, safe drinking water, good food hygiene and appropriate sanitation.
Handwashing with soap and water after using the toilet and before preparing food is especially important. Travellers visiting areas with unreliable sanitation should take precautions with food and water and consider vaccination before departure.
Raw or inadequately cooked shellfish can pose a hepatitis A risk, particularly when harvested from contaminated waters. Consumers should follow relevant food safety warnings and recall notices during suspected outbreaks.
Preventing hepatitis B requires a different approach. Vaccination, safer sexual practices, sterile medical equipment and avoiding the sharing of needles or sharp personal items are central to reducing transmission.
Healthcare workers should follow established infection-control procedures, and pregnant women should receive hepatitis B screening in accordance with national recommendations to protect newborns from preventable infection.
For someone already living with chronic hepatitis B, attending recommended medical appointments, receiving appropriate treatment and undergoing liver monitoring can substantially reduce the likelihood of severe complications.
Why hepatitis remains a major global health challenge
The continued burden of hepatitis A and B demonstrates that the availability of effective vaccines does not automatically eliminate an infectious disease.
Hepatitis A outbreaks are often linked to gaps in sanitation, food safety and vaccination coverage. Even countries with modern healthcare systems can experience significant outbreaks when contaminated food products or person-to-person transmission reach susceptible populations.
Hepatitis B presents an even greater long-term challenge. Hundreds of millions of people are living with chronic infection, yet most remain undiagnosed, and only a small minority currently receive treatment.
WHO's 2026 Global Hepatitis Report concluded that progress towards eliminating viral hepatitis as a major public health threat by 2030 remains insufficient. Preventing infections at birth, improving vaccination coverage and expanding access to diagnosis and antiviral treatment are among the most important priorities.
The distinction between hepatitis A and B is ultimately straightforward but medically significant. Hepatitis A usually causes a temporary illness that the body clears, while hepatitis B can remain hidden for decades and cause irreversible liver damage.
Both are preventable through vaccination, and recognising an infection early can make an enormous difference. For hepatitis B in particular, a simple blood test may identify a disease long before symptoms develop, potentially preventing complications that would otherwise emerge years later.
This article is made and published by Aksel Kryhlmand, who may have used AI in the preparation.