• Although anyone can get hepatitis A, in the United States, certain groups of people are at higher risk, such as:
• People who use drugs (injection or non-injection)
• People experiencing unstable housing or homelessness
• People who are currently or were recently incarcerated
• Men who have sex with men (MSM)
• People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
• People with direct contact with someone who has hepatitis A
• Travelers to countries where hepatitis A is common
• Household members or caregivers of a recent adoptee from countries where hepatitis A is common
• People with clotting factor disorders, such as hemophilia
• People working with nonhuman primates

Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.

Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.

The hepatitis B virus is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus from:

• Birth (spread from an infected mother to her baby during birth)
• Sex with an infected partner
• Sharing needles, syringes, or drug preparation equipment
• Sharing items such as toothbrushes, razors or medical equipment such as a glucose monitor with an infected person
• Direct contact with the blood or open sores of an infected person
• Exposure to blood from needle-sticks or other sharp instruments of an infected person

Hepatitis B virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

• Sharing needles, syringes, or other equipment to prepare or inject drugs
• Needlestick injuries in health care settings
• Being born to a mother who has hepatitis C

Less commonly, a person can also get hepatitis C virus through

• Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
• Having sexual contact with a person infected with the hepatitis C virus
• Getting a tattoo or body piercing in an unregulated setting

Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Some people are at increased risk for having hepatitis C, including:

• Current or former injection drug users, including those who injected only once many years ago
• Those born from 1945 through 1965
• Recipients of clotting factor concentrates made before 1987, when less advanced methods for manufacturing those products were used
• Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donors became available
• Hemodialysis patients
• People with known exposures to the hepatitis C virus, such as
  • Health care workers after needle sticks involving blood from someone who is infected with the hepatitis C virus
  • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
• People with HIV infection
• Children born to mothers infected with the hepatitis C virus
• People who are incarcerated
• People who use intranasal drugs
• People who received body piercing or tattoos done with non-sterile instruments