Center for HIV and Hepatogastroenterology

Dr. med. S. Mauss G. Schmutz Dr. med. P. Hegener Dr. med. C. Athmann

Your specialists for HIV and Hepatitis

Viral hepatitis | Risks & protection

Being well informed can help

Knowing about the different hepatitis viruses and their modes of transmission is a prerequisite to protect yourself and others against an infection. Therefore, in this chapter we have summarized some important key issues about the risks and prevention of infection. The key words on the right side will lead you to short answers on the following frequently asked questions:

  • What are the modes of transmission and how do the viruses enter the body?
  • What is the mode of infection?
  • Which are high risk situations?
  • Who is particularly at risk for infection?
  • In which countries should travellers be particularly careful?
  • What are the appropriate medical actions and how can I protect myself in everyday life?

Transmission of viral hepatitis

Hepatitis can be transmitted through contact- and smear infection

Situations of transmission

  • Faecal contacts (A, E)
  • Contaminated Food (A, E)
  • Blood contacts (A, B/D, C, E)
  • Sexual contacts (A, B/D, C, E)
  • Mother-to-child (B/D, C, E)
  • Needlestick injury (B/D, C)

Modes of transmission

  • oral (A, E)
  • small skin injuries (B/D, C)
  • small mucosal injuries (B/D, C)

Carrier substances

Substances that can transmit hepatitis viruses are:

blood x x x x
excrements x x
body fluids
hemorrhagic saliva x x
seminal fluid x x
vaginal fluid x x
polluted water x x
juices x
undercooked meat (in particular wild boar, pig) x
vegetables exposed to faeces (e.g. salad) x x
seafood (e.g. mussles) x x
blood products (routine screening established in most developed countries)
blood pads x x x
tooth brush x x x
razor x x x
nail scissors x x x
syringes x x x
contaminated instruments for tattooing, piercing, ear-piercing x x x

Risk factors

The following conditions increase the risk for an infection:

  • travelling to areas with poor hygienic standards or endemic areas
  • intravenous drug use
  • unsafe sexual contacts

Due to contact with infected persons or procedures with a potential risk of transmission, the risk of infection is also higher in the following situations:

  • working in hospitals
  • working in jail, psychiatry or asylum
  • living in household with infected persons
  • surgical interventions (in case of poor hygienic standards)
  • dental treatment (in case of poor hygienic standards)
  • needlestick injury
  • poor hygienic conditions
  • tattoos (in case of poor hygienic standards)
  • (ear-)piercings (in case of poor hygienic standards)
  • picking and biting between infected toddlers

Blood bottles and blood products

The current third-generation blood test systems have reduced the risk of transmission to approximately 1:100,000-300,000. Since the introduction of the HCV nucleid acid test in Germany in April 1999, the risk of being infected by HCV-contaminated blood or blood product infusions is estimated to be < 1x1005

Groups at high risk

Viral hepatitis is not accompanied by specific symptoms except in case of jaundice; in most cases however an acute hepatitis occurs without jaundice.

Persons at high risk are:

  • travellers to developing world countries
  • intravenous drug users
  • persons with multiple sex partners
  • homosexual men
  • healthcare professionals
  • inmates, persons working in jails
  • patients undergoing dialysis
  • hemophiliacs


There are various possibilities to prevent an infection with hepatitis viruses:

Medicinal actions

  • active vaccination (HAV, HBV)
  • passive immunization immediately after risk contact (if no antibodies are present) (HBV)
  • preventive measures (viral therapy for the mother, active/passive vaccination after birth) for the embryo/newborn (HBV/HDV)
  • testing of blood products (HBV/HDV, HCV)

Self-protection in profession and everyday life

  • avoidance of direct blood-to-blood contact (HAV, HBV/HDV, HCV, HEV)
  • avoidance of faecal-oral contacts (HAV, HEV)
  • no needle sharing or sharing of the devices (e.g. spoon and other tools, HBV, HCV)
  • use of one-way materials (HAV, HBV/HDV, HCV, HEV)
  • use of sterile equipment (HBV/HDV, HCV)
  • cooking of food (HAV, HEV)
  • cooking of water (HAV, HEV)
  • chemical desinfection (HAV, HBV/HDV, HCV, HEV)
  • protective gloves (HAV, HBV/HDV, HCV, HEV)
  • use of face masks and safety goggles (HAV, HBV/HDV, HCV, HEV)


Vaccines are available against HAV and against HBV (which is also effective against HDV).
A vaccination against HBV is recommended for all children and adolescents.
Travellers to high-endemic areas are recommended to be vaccinated against both HAV and HBV. A vaccine against HEV is only approved in China.