Hepatitis

Hepatitis A, B, and C share the same organ but differ in transmission, chronicity, and vaccine availability — confusing them costs NCLEX points and puts patients at risk.

Hepatitis is liver inflammation most commonly caused by viral infection. The NCLEX focuses on types A, B, and C. Hepatitis A (HAV) spreads fecal-oral, is always acute, never becomes chronic, and is preventable with a vaccine. Hepatitis B (HBV) spreads through blood and body fluids (percutaneous, sexual, perinatal), can become chronic in about 5% of immunocompetent adults (~90% in perinatally infected infants), and is preventable with a vaccine — the only hepatitis with both a vaccine and risk for chronicity. Neonates born to HBsAg-positive mothers require HBIG plus HBV vaccine within 12 hours of birth. Hepatitis C (HCV) spreads primarily through blood (IV drug use, needlesticks), has no vaccine, and becomes chronic in approximately 75-85% of those infected, making it the leading cause of liver transplant in the U.S. HCV is now curable with direct-acting antivirals (DAAs) achieving >95% sustained virologic response, making early screening and referral a nursing priority. Key lab markers: elevated ALT and AST indicate hepatocyte damage; rising bilirubin causes jaundice. Serologic markers differentiate types — anti-HAV IgM confirms acute A; HBsAg confirms active B infection; anti-HBc IgM indicates acute HBV or window period; anti-HCV confirms C exposure. Nursing priorities include standard and transmission-based precautions (contact for diapered or incontinent HAV patients; standard precautions for continent adults with HAV and for all HBV/HCV patients), monitoring for progression to fulminant liver failure, and patient education on preventing transmission.

Key Distinctions

Don't confuse HBsAg (surface antigen = active infection/carrier) with anti-HBs (surface antibody = immunity from vaccine or resolved infection) — one means infectious, the other means protected. Anti-HBc IgM indicates acute HBV or the window period (HBsAg cleared, anti-HBs not yet present); anti-HBc IgG indicates past or chronic infection. Students often think hepatitis C has a vaccine because B does — it does not. HAV requires contact precautions for diapered or incontinent patients (fecal-oral route); continent adults need standard precautions only. HBV and HCV are bloodborne and require standard precautions.

Clinical Pearl

A is Acute only and has A vAccine. B is in Blood/Body fluids and has Both a vaccine and chronicity risk. C is Chronic most often and has no vaCCine (but is curable with DAAs).