Hepatitis Viruses


Viral hepatitis, characterised by inflammation of the liver and necrosis of hepatocytes, results from infection with viruses from several different families. The essentially hepatotropic viruses include a range of five different unrelated human pathogens: hepatitis A, B, C, D and E.

Viral hepatitis is a major public health problem. The World Health Organisation estimates that 1 in 12 of the human population has been infected with the hepatitis viruses. Over one‐third of the world population, some two billion people, have been infected with hepatitis B virus, and four million cases of acute hepatitis B occur every year. Reliable estimates for infection with hepatitis A, C, D and E are not available.

Hepatitis causes considerable morbidity and mortality, from both acute infection and chronic sequelae. It is estimated that there are over 350 million carriers of hepatitis B virus worldwide, and some 250 million carriers of hepatitis C virus.

Key Concepts:

  • Viral hepatitis remains a major public health problem with considerable morbidity and mortality.

  • Persistent infection may progress to chronic liver disease, cirrhosis and primary liver cancer.

  • Liver cancer is the seventh most common cancer in males and the ninth most common cancer in females.

  • Strategies for the prevention of viral hepatitis are still evolving, for example, effective vaccines and universal immunisation.

  • There is an urgent need to develop vaccines against infection with hepatitis C virus and hepatitis E virus infection in some developing regions of the world.

  • There is an urgent need to develop and apply new and more effective antiviral drugs.

  • The need to implement some basic public health measures to reduce the burden of infection with the hepatitis viruses, for example, social conditions and health education.

  • Paid blood donations, which are known to carry a high risk of transmissible viral infections, should be prohibited by law.

  • It is essential that national public health authorities ensure the safety of injections, as the estimated total burden of infection due to unsafe injection practices in developing countries (WHO study, 2000) is 21 million cases of hepatitis B; 2 million cases of hepatitis C and 260 000 cases of HIV infection.

  • Control of viral hepatitis will lead to a highly significant improvement of health in all countries.

Keywords: hepatitis viruses; primary liver cancer; persistent infection; antiviral therapy; vaccines; cirrhosis; public health; morbidity and mortality

Figure 1.

Electron micrograph of Hepatitis A virus in a faecal extract, ×4 00 000. From a series by Thornton and Zuckerman.

Figure 2.

Electron micrograph of whole serum showing the three morphological forms of hepatitis B: small pleomorphic surface antigen particles; tubular forms and the complete double‐shelled hepatitis B virions, ×2 00 000. From a series by Zuckerman et al.

Figure 3.

The genomic structure of Hepatitis B virus. aa, amino acids; HBcAg, hepatitis B core antigen; HBsAg, hepatitis B surface antigen and ORF, open reading frame.



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Further Reading

Harrison TJ and Zuckerman AJ (1996) The Molecular Medicine of Viral Hepatitis, pp. 1–271. Chichester, UK: Wiley.

Hollinger FB and Ticehurst JR (1996) Hepatitis A virus. In: Fields BN, Knipe DM and Howley PM (eds) Fields Virology, 3rd edn, vol. 1, pp. 735–782. Philadelphia, PA: Lippincott‐Raven.

Leary TP, Muerhoff AS, Simons JN et al. (1996) Sequence and genomic organization of GBV‐C: a novel member of the Flaviviridae associated with human non‐A–E hepatitis. Journal of Medical Virology 48: 60–67.

Lee WM (ed.) (1999) Hepatitis B. Clinics in Liver Disease, vol. 3 no. 2, pp. 1–432. Philadelphia, PA: W.B. Saunders.

Morbidity and Mortality Weekly Report (1998) Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV‐related chronic disease. Morbidity and Mortality Weekly Report 47(19): 1–39.

Mushahwar IK (ed.) (2004) Viral Hepatitis: Molecular Biology, Diagnosis, Epidemiology and Control. Perspectives in Medical Virology, vol. 10, pp. 1–264. Amsterdam: Elsevier.

National Institutes of Health (1997) Management of Hepatitis C. NIH Consensus Statement 15: 1–41.

Thomas HC, Lemon S and Zuckerman AJ (eds) (2005) Viral Hepatitis, 3rd edn. Oxford, UK: Blackwell.

Verme G, Bonino F and Rizzetto M (eds) (1983) Viral Hepatitis and Delta Infection, pp. 1–42. New York: Alan R. Liss.

World Health Organisation (1983) Prevention of Liver Cancer. Technical Report Series: 691. Geneva: WHO.

Zuckerman JN and Zuckerman AJ (2010) Hepatitis viruses. In: Cohen J, Powderley WG and Opal SM (eds) Infectious Diseases, pp. 1539–1549. Edinburgh, UK: Mosby Elsevier.

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Zuckerman, Arie J(Mar 2011) Hepatitis Viruses. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0000415.pub3]