Transmission of Viral Hepatitis

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Transmission of hepatitis A virus

Virus transmission via faecal-oral route

HAV is spread by the faecal–oral route. It is eliminated in the faeces of infected people and usually found in contaminated food or water. It is common in regions with poor hygiene conditions (Southeast Asia, India, Africa and parts of South America) where there is untreated water and people visiting these areas without being immunised (protected) are at risk of infection.

In European countries, it mainly affects children under 5 years old and tends to course without symptoms. Nowadays, following improvements in hygiene and sanitary conditions, most of the adult population has never been exposed to hepatitis A, so they are not immunised (protected) and carry the risk of being infected. In Catalonia, a pilot vaccination programme was initiated in 1994 for all 12-year-old schoolchildren and in 2014 the hepatitis A vaccine was included in the childhood vaccination schedule. In the rest of Spain, however, universal vaccination has not been implemented.

There is currently an outbreak of hepatitis A across Europe in men who have high-risk sex with other men, so vaccinations are recommended for this group as they are particularly at risk of infection.

Transmission of hepatitis B virus

Hepatitis B is transmitted through contact with blood and other biological fluids such as saliva, semen, vaginal secretions and urine.

Symbol of man and woman

Sexual transmission through unprotected sex. This is the most common route of transmission in developed countries, with homosexual men and heterosexual partners with risky behaviours most at risk.

Injection crossed out

Percutaneous transmission.

  • Sharing infected needles or materials for injecting or inhaling drugs.
  • Accidental needle stick injuries (e.g., healthcare personnel).
  • Situations where insufficiently sterilised materials may be reused such as during dental treatments and when carrying out tattoos, piercings or micropigmentation.
Perinatal (mother-to-child) transmission of a virus

Perinatal or vertical transmission. Transmission from mother to baby can occur in the uterus, or during or after childbirth. Most infections take place during or shortly before birth. The rate of infection may be as high as 90%. Nevertheless, vaccination immediately after delivery and the use of hepatitis B immunoglobulin are highly efficient in up to 95% of cases. Incidentally, caesarean deliveries do not seem to be as protective as they are for other vertically transmitted diseases such as HIV, hence they are not recommended as a specific means of preventing transmission.

Toothbrush with toothpaste

Horizontal transmission. Hepatitis B can be spread by objects, upon which the virus can remain stable for up to 7 days, by means of non-sexual and non-vertical transmission. Infection can still arise over this period if the object penetrates the body of someone who has not been protected by vaccination, for example through the shared use of personal hygiene instruments and utensils (toothbrush, razor, nail clipper, etc.) with a hepatitis B carrier.

The best way to prevent hepatitis B is by getting vaccinated.

Preventing the transmission of Hepatitis B

There is a safe, effective injectable vaccine available to prevent transmission if infected with the hepatitis B virus. It has an efficacy of 95% in terms of preventing this chronic disease and offers protection for at least 20 years.

In Spain, the hepatitis B vaccine forms part of the vaccination schedule for all newborn children. It typically consists of three doses of vaccine: the first is given at birth, followed by two more doses at 1 and 6 months. At present, the administration of a booster dose is not recommended apart from in special situations (immunosuppression).

Sexual partners, high-risk sexual contacts and members of the same household who live in close contact with hepatitis B carriers should undergo a hepatitis B test and are also advised to get vaccinated against the virus.

Transmission of Hepatitis C virus

Syringe that injects corticosteroids into the hand

Through blood (parenteral route):

  • The use of contaminated blood or blood products during transfusions or medical/sanitary procedures carried out before 1992. Nowadays all blood donations are screened before they are used, so there is only a residual risk of transmission through blood products.
  • Sharing infected needles or materials for injecting or inhaling drugs. Drug use is currently the main means of infection in developed societies.
  • Accidental needle stick injuries (e.g., healthcare personnel).
  • Sharing personal hygiene instruments and utensils (toothbrush, razor, nail clipper, etc.) with a hepatitis C carrier.
  • Situations where insufficiently sterilised materials may be reused such as during dental treatments and when carrying out tattoos, piercings or micropigmentation.
Symbol of man and woman

Sexual and perinatal transmission (non-parenteral route):

The sexual transmission of hepatitis C is rare, but it can occur. It has been confirmed that the transmission between stable heterosexual partners is very rare and therefore no special precautions are recommended. However, the use of barrier methods such as condoms eliminates the risk of sexual transmission. The risk is increased by high-risk sexual behaviours:

  • Sexual promiscuity.
  • Anal sex (fissures or wounds, mucous membrane lesions).
  • Oral sex (mouth ulcers or bleeding gums).
  • Sex during the menstrual period (as there is direct contact with blood).
  • Perinatal vertical transmission (from mother to child). There is a low risk of transmission, less than 5%.

There is no vaccine for hepatitis C and therefore prevention is essential.

Hepatitis C cannot be transmitted by:

Breast and baby suckling

Breast milk (but breastfeeding mothers should check they do not have any cracks or wounds on their nipple or areola).

Pale person with heavy sweating

Saliva, sweat or tears. Coughing, sneezing or through public swimming pools or similar activities.

Two people kissing

Hugging, kissing or holding hands.

Person drinking a standing glass of water

Sharing kitchen utensils, meals or drinks with an infected person.

Washing machine with laundry basket

Bloodstained clothes (they can be washed along with the rest of the family’s clothes and the usual laundry detergent).


Mosquito bites.

Transmission of Hepatitis E virus


Se transmite a través de la vía fecal-oral. Es una causa frecuente de brotes epidémicos de hepatitis en países subdesarrollados con malas condiciones higiénicas. Sin embargo, en los países europeos, incluida España, el virus de la hepatitis E se encuentra en animales como el cerdo, el jabalí o los ciervos. Su contagio suele ser con la ingesta de carne cruda o poco cocinada.

Substantiated information by:

Concepció Bartres Viñas
Sergio Rodríguez Tajes
Xavier Forns Bernhardt
Zoe Mariño Mendez

Published: 20 September 2018
Updated: 20 September 2018

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.


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