Viral hepatitis A, B, C, D and E compared

The NHS lists the usual signs of hepatitis as yellowing of the skin and whites of the eyes, itching, pain under the right ribs, pale stools, dark urine, marked tiredness, nausea, fever and loss of appetite. Jaundice can be harder to spot on brown or black skin. These effects usually last one to three weeks, and flu-like symptoms or diarrhoea can come first for about five to seven days.

The hard part is that many people feel nothing, or feel nothing until years later. Because of that, the virus type cannot be guessed from how someone feels; blood tests are what separate the five, and what separates a short illness from a long-term infection.

The table summarises the points that most change what happens next. It is drawn from NHS and WHO pages and does not replace a clinician's assessment.

Both are usually self-limiting. WHO gives the usual incubation of hepatitis A as 14 to 28 days and notes that it does not cause chronic liver disease, although a very small proportion of people develop fulminant hepatitis. There is no antiviral for it, so management is rest, hydration and nutrition, and WHO advises avoiding unnecessary medicines that stress the liver, such as paracetamol.

Hepatitis E is different in the UK because the NHS says it is usually caught here from raw or undercooked meat, typically pork, or shellfish. Most people recover without treatment, but pregnancy or a weakened immune system can make the illness serious, and WHO notes that rare chronic infection has been reported in transplant recipients. WHO gives the incubation as 2 to 10 weeks and describes the illness as typically resolving within 2 to 6 weeks.

Hepatitis B passes through blood, semen, vaginal fluids and saliva in the presence of cuts, from mother to baby, and via unsafe injections or sharp objects. WHO says that infection in infancy or early childhood becomes chronic in about 95 per cent of cases, compared with under 5 per cent when acquired in adulthood, which is why the baby vaccine matters. Chronic infection is treated with oral antivirals such as tenofovir or entecavir, which suppress the virus.

Hepatitis C spreads through infected blood. WHO states that around 30 per cent of people clear it without treatment, that the rest develop chronic infection, and that cirrhosis risk is 15 to 30 per cent within 20 years of chronic infection. A positive antibody test needs an RNA test to confirm active infection. Direct-acting antivirals taken for usually 12 to 24 weeks can cure most people.

Hepatitis D only infects people who already have hepatitis B. WHO calls chronic co-infection the most severe form of chronic viral hepatitis because it progresses faster to liver failure and liver cancer. Hepatitis B vaccination prevents it.

Chronic hepatitis B, C or D can lead to cirrhosis, liver failure and liver cancer, and the NHS notes that a liver transplant may be needed if damage is severe. Long-term infections therefore need specialist follow-up, monitoring of liver scarring and, where appropriate, treatment.

If you have had a blood exposure, an unprotected sexual risk, shared needles, tattoos or piercings with poorly cleaned equipment, or live in or came from an area where hepatitis B or C is common, ask a GP or sexual health service about testing. Immunity checks for hepatitis A and B also help when planning travel.

The NHS advises an urgent GP appointment or NHS 111 if you think you have hepatitis, and always 111 for a child under 5. Severe drowsiness, confusion or vomiting blood are emergencies and warrant 999 or A&E.