Category Archives: Native American Health

States look for help with bilingual mental health


From a string of public suicides in Alaska to assimilation anxiety among young Hispanics in Cleveland, states are faced with the need for more bilingual and culturally sensitive mental health care professionals

Illustration of the skull and brainBy Tim Henderson

The U.S. is grappling with a severe shortage of mental health professionals. But the situation is particularly dire for some minority communities, where barriers of language and culture can make it hard to seek and get help.

Most good mental health care requires subtle, intimate conversation with patients. But too often, mental health experts say, professionals lack the language skills needed to serve those who struggle with English.

The greatest mental health needs are often in remote, rural areas with scattered populations.

“It’s difficult to trust that translation will capture nuances in the soul-baring process of mental health treatment,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness (NAMI).

The greatest mental health needs are often in remote, rural areas with scattered populations. Continue reading


US awards $21 million to support tribal domestic violence programs


From the US Department of Health and Human Services and the Indian Health Service

indian-health-services-seal-200pxThe U.S. Department of Health and Human Services Administration for Children and Families (ACF) and Indian Health Service (IHS) announced Thursday the award of nearly $21 million to support tribal domestic violence victims and organizations in American Indian and Alaska Native communities across the nation.

ACF funding announced today is being awarded under the Family Violence Prevention and Services Act (FVPSA), which is the primary federal funding source dedicated to providing immediate shelter and supportive services for victims of family violence, domestic violence, or dating violence and their dependents.

Grants will be awarded to 136 tribes and tribal organizations serving 274 tribes.

These funds will help to strengthen tribal responses to domestic violence and emphasize public awareness, advocacy, and policy, training, and technical assistance. Continue reading


Longevity and health in later life vary greatly by community in L.A.

3-D Perspective image of the Los Angeles Basin from the Landsat satellite using NASA's Shuttle Radar Topography Mission (SRTM) for topography information. The vertical scale is exaggerated one and half times.

3-D Perspective image of the Los Angeles Basin from the Landsat satellite using NASA’s Shuttle Radar Topography Mission (SRTM) for topography information. The vertical scale is exaggerated one and half times.

By Anna Gorman

report on aging in Los Angeles County, the nation’s largest county and one of its most diverse, shows wide disparities in life expectancy among different ethnic groups and neighborhoods.

Overall, the life expectancy for Los Angeles County residents was about 82 years in 2011, up from nearly 76 in 1991, according to the report by University of Southern California’s Roybal Institute on Aging. Much of that can be attributed to drops in coronary heart disease, strokes and lung cancer, the report noted.

But African Americans can expect to live to an average of about 76 years whereas the average for Asians and Pacific Islanders approaches 86 years, the report said.

And residents who have reached the age of 50 in the more affluent western part of the county are expected to live about five years longer than those in largely poor South Los Angeles.

Similarly, researchers found stark differences among ethnic groups when it comes to chronic disease. Latinos in L.A. County aged 50 or older have nearly double the rate of diabetes as whites, and older African Americans have a much higher rate of hypertension than other ethnic groups. Continue reading


Tried to sign up but couldn’t finish by the deadline?


Washington Healthplanfinder outlines steps you need to take to qualify for special enrollment

From Washington Healthplanfinder:

Coverage is hereWith the deadline to enroll in a Qualified Health Plan through now passed, Washington Healthplanfinder is reaching out to residents who couldn’t complete their application by March 31 with important guidance to qualify for a special enrollment.

Washingtonians who were prevented from submitting their application by the deadline should complete these steps as soon as possible to qualify for coverage that begins May 1, 2014. Continue reading


How states are tackling ‘health disparities’


Question Q&ABy Michael Ollove
Stateline Staff Writer

African-Americans are more likely to suffer heart disease and diabetes than whites. The cancer death rate for men is a good deal higher than it is for women.

American Indians and Alaska Natives are more likely to smoke tobacco than Hispanics, blacks or whites.

And Native Hawaiian adults are less likely to exercise than other ethnic groups.

These differences are called “health disparities,” and in the last two decades, the federal government and the states have focused on eliminating them. Continue reading


Does Indian Health Service coverage meet the requirements of the individual mandate?


indian-health-services-seal-200pxBy Michelle Andrews

Q. If our son is able to get healthcare from the local Indian Health Clinic, is he still required to get Obamacare insurance?

A. He may not be. Starting in January, most people have to have health insurance that qualifies as “minimum essential coverage” under the law or face a penalty.

Job-based health insurance, Medicare Part A, Medicaid and Tricare, the health program for members of the military and their families, all meet the standards for minimum essential coverage under the health law.

About 2 million American Indian and Alaskan Native tribe members receive health care at 600 Indian Health Service facilities around the country. But IHS services aren’t health insurance, nor do they meet the standards for minimum essential coverage.

However, members of federally recognized tribes are one of several groups exempt from the penalty for not having insurance. Others include people who can’t afford coverage or are experiencing a hardship, or those who have a short gap in coverage of less than three months.

In 2014, the penalty for not having insurance will be $95 or 1 percent of family income, whichever is greater. That amount will increase to $695, or 2.5 percent of income in 2016.

Members of Indian tribes who qualify can complete a form to apply for an exemption from the requirement to have insurance. The form is currently under development, according to an IHS spokesperson.

Please send comments or ideas for future topics for the Insuring Your Health column We regret that we can’t respond to individual requests for health insurance advice or information. Please visit to locate a health insurance expert in your area.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


ACA – A hard sell for Native Americans


indian-health-services-seal-200pxBy Christine Vestal
Stateline Staff Writer

For most uninsured Americans, the motivation for checking out the health insurance exchanges is simple – they could face stiff penalties if they don’t sign up. For Native Americans, the decision is more complicated.

Longstanding treaties with the federal government guarantee all Native Americans free health care. As a result, the Affordable Care Act exempts them from paying a penalty if they choose not to purchase insurance.

More than 2 million Native Americans receive free health care at federally supported Indian health facilities. Many others receive care from tribal facilities and urban Indian organizations.

So why would an American Indian or Alaska Native sign up for reduced-rate insurance on the exchanges?

Indian health advocates said the benefits are many. “It’s an unprecedented opportunity,” said Roxane Spruce Bly, who is working with New Mexico’s health insurance exchange to provide outreach to Native Americans. “It’s the biggest thing to happen in Indian health in my lifetime. It solves so many problems for Indian people.”

Although tribal members are entitled to free health care, most Indian health facilities do not offer a full array of services. When patients need major surgery or cancer treatments, for example, they are referred to specialists outside of Indian lands.

At least two-thirds of those referral claims are rejected, Bly said. That puts Indians at risk of either paying major medical bills themselves or doing without needed treatments. In addition, about half of Native Americans live in urban areas that are great distances from tribal health facilities.

As a group, the nation’s 5.2 million Native Americans have poorer health and less access to health care than the rest of the U.S. population. Their uninsured rate is nearly 30 percent, compared to 15 percent for the country as a whole.

And nearly half of all Indians have incomes low enough to qualify for Medicaid in states that have chosen to expand coverage, according to the Center on Budget and Policy Priorities. More than 1 million Native Americans are already enrolled in Medicaid.

Still, Bly and others said the idea of purchasing health insurance, even if deeply discounted, is a foreign concept for most tribal members. Even optimistic advocates for Indian enrollment in the exchanges said convincing tribal leaders and individuals to sign up could take years. Bly’s goal is to sign up 10 percent of New Mexico’s eligible Native Americans by the end of 2014.

20 States with Most Native Americans
  • California 739,964
  • Oklahoma 415,371
  • Arizona 366,954
  • New Mexico 215,605
  • New York 194,714
  • Washington 188,071
  • Michigan 128,335
  • Alaska 126,999
  • Oregon 104,143
  • Colorado 102,451
  • Minnesota 95,130
  • Wisconsin 82,335
  • South Dakota 76,205
  • Montana 74,399
  • Nevada 60,283
  • Utah 53,679
  • Massachusetts 45,653
  • North Dakota 40,740
  • Idaho 36,464
  • Wyoming 18,692
Source: Census Bureau

Special Advantages

The ACA includes provisions for American Indians and Native Alaskans that make purchasing insurance on the exchange an even better proposition than it is for everyone else.

They can sign up at any time – there are no open enrollment deadlines. Tribal members with incomes below 300 percent of the federal poverty level ($34,470 for an individual) are exempt from paying deductibles and copays, so they can purchase the cheapest plans without worrying about out-of-pocket expenses.

All tribal members, no matter what income level, are exempt from out-of-pocket payments if they receive services from Indian health facilities. And unlike employers, tribes can pay exchange premiums for their members without paying taxes.

In addition, a separate law that has governed Native American health care for decades – the Indian Health Care Improvement Act – was amended when the ACA was signed.

New provisions make it easier for Indian health facilities to accept payments from other insurers, including Medicaid, Medicare and private insurance.

The new law also expands the types of services the facilities can offer and requires inclusion of behavioral health and substance abuse treatments.

For Indians enrolled in Medicaid, Indian health providers receive a fee-for-service that is much higher than other providers receive. In addition, they can collect fees from private insurers if Native Americans take advantage of the exchanges.

The new income sources are expected to help Indian health facilities expand and improve their services. Some, for example, do not now include dentistry or deliver babies.

Few offer preventive services. According to a 2011 Centers for Medicare and Medicaid (CMS) report, the Indian Health Service budget—$4.2 billion in 2010—“is only sufficient to provide about half the necessary health services required.”

Ed Fox, a member of a tribal advisory group to the CMS, estimates the ACA could result in as much as $4 billion in additional revenue for Indian health services. But that’s only if tribal leaders take advantage of it, he said.

A tribal member himself, Fox conducts outreach meetings with tribal leaders in Washington state. He said so far the leaders he’s talked with plan to wait and see what other tribes do about the health insurance exchanges before they make a decision.

“They haven’t had the greatest experience with government programs in the past,” Fox said. If he walks into a meeting and says, “I’m with the federal government and I’m here to help you,” most tribal leaders simply laugh.

Medicaid Expansion

In states that expand Medicaid in January, enrolling newly eligible Native Americans will be less of a challenge than selling the exchange concept. But it will still take substantial state and federal outreach and education, an effort that is required by the ACA.

According to a report from the Government Accountability Office, Native American enrollment in Medicaid could double under the expansion.

But the GAO said the CMS and the Indian Health Service are not doing enough to spread the word about health insurance exchanges and new Medicaid coverage. States are also responsible for getting the word out.

In New Mexico, Medicaid director Julie Weinberg said members of her staff have been crisscrossing the sparsely populated state since August and have visited more than 200 tribal locations.

The agency has also purchased radio, print and television ads. “It ends up being fairly costly,” Weinberg said. “We’re digging way down deep into our administrative budget to do the outreach.”

Montana and California have received a federal Medicaid waiver to directly reimburse tribal leaders for Medicaid expansion outreach efforts.  Alaska and Washington have pending waiver requests, and three other states are interested, according to the GAO report.

In general, the federal government will pay 100 percent of all costs for newly eligible Medicaid enrollees for the first three years. After that the federal share tapers to 90 percent. Traditionally, however, the federal government has paid 100 percent of all Medicaid costs for Native Americans.

“The most important thing for state administrators,” said Carolyn Ingram of the Center for Health Care Strategies, “is to talk to tribes early and often.” She and others agree that most individual Native Americans are not likely to take full advantage of the health law without the support of their tribal elders.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Abortion thumbnail

Abortion laws force closure of women’s health clinics serving the poor

Abortion Knoxville-march-for-life-2013-3

Photo: Brian Stansberry / Creative Commons

By Jake Grovum, Staff Writer

New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services.

In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly.

Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet.

Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions.

“Every time a clinic closes, the women who would be using those clinics, it’s not as if those women stop existing,” said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health, an advocacy group. “It will affect whether women can get cancer screenings, whether women can get to a provider to get their blood pressure checked.”

“Clinics that serve women who may not have insurance are literally a lifeline,” McGuire said.

Fifteen states now require clinic doctors to have hospital admitting privileges, according to the Guttmacher Institute, which supports abortion rights.

In addition, 26 states require abortion-providing clinics to meet surgical facility standards, which stipulate everything from the size of certain rooms, the types of light switches used and the width of hallways.

Supporters say such requirements are common-sense public health measures. They cite high-profile examples of poor oversight and gruesome malpractice cases, most notably the Kermit Gosnell case in Philadelphia.

“What is so wrong about having high health standards in place?” asked Alabama Rep. Mary Sue McClurkin, who sponsored legislation which includes clinic regulations and requirements for doctors that has been blocked by a federal judge. “If they would just do what was in the best interest of the patient, it would not be a problem.”

Opponents of such laws say they might close a vital health care entryway for women. In many states, the clinics offer services ranging from sexually transmitted disease testing and treatment to mammograms, Pap tests and cancer screenings.

They also offer family planning counseling and birth control services—in many cases at reduced fees for the uninsured.

In 2011 and 2012, the Guttmacher Institute conducted a survey of women receiving services at family planning centers located in communities in which there were other health care options.

About four in 10 women said they used a clinic as their exclusive health care provider in the past year. Among other reasons, the women said they preferred going to a clinic because staff there knew more about women’s health and it was easier to talk to them about sex.

The connection between the clinics, public health care programs and women’s health was further underscored by a Kaiser Family Foundation study.

The report noted that in many states, there are few providers willing to accept Medicaid or other subsidized insurance programs. In those places, the clinics are a vital, and sometimes the only, option for low-income people.

For example, in 2011 Texas blocked Planned Parenthood-affiliated health centers from receiving funds from the state’s Medicaid Women’s Health Program.

Prior to the funding cut-off, those centers were caring for nearly 50,000 patients. The program served 63 percent fewer women the year after the cuts, state data showed.

The American Congress of Obstetricians and Gynecologists has also argued that clinic closings could damage women’s health. The group blasted Texas’ new abortion law and measures under consideration in North Carolina.

Those who back the laws argue the regulations would make the clinics safer.

So far, courts haven’t bought that argument, seeing laws that could shutter clinics as potentially unconstitutionally restrictive of abortion.

Courts already have blocked physician requirements in Mississippi and Alabama. Last week, Wisconsin’s law was temporarily blocked by a federal judge and advocates are preparing to fight Texas’ law as well.

“The courts have seen right through the arguments that this is somehow supposed to protect women’s health,” said Julie Rikelman of the Center for Reproductive Rights, which is involved in the legal fights.  “These laws really hurt women’s health, not help them.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.


Despite challenges, community health centers win high satisfaction rates


Doctor at deskBy Valerie DeBenedette
HBNS Contributing Writer

Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers, reveals a new study in the Journal of Health Care for the Poor and Underserved.

The level of satisfaction shown by people who use the health centers was surprising, said lead author Leiyu Shi, DrPH, MBA, MPA, professor at the Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, M.D.

Because the centers treat a more vulnerable population, they often have a more difficult time addressing their patients’ needs, he noted. Yet, the study shows that health centers appear to be reducing gaps in both quality of service and accessibility, he said.

Federally funded health centers are usually located in medically underserved communities, making them more likely to be either in inner city or rural areas, explained Shi.

Patients using these centers are more racially and ethnically diverse than the national population and more likely to be uninsured (39 percent compared to 17 percent) or to receive Medicare or Medicaid (54 percent compared to 27 percent) and to be in fair to poor health than the general population.

But patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere (87.2 percent).

Patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere.

“This study tells us a lot about the role of a safety net system,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association in Washington, D.C.

Federally qualified health centers have become like other health providers, but are more focused on primary care and preventive medicine, he noted.

They are based in the community, with one federal requirement being that 51 percent of the members of their board of directors be from the community. They can bill private health insurance, Medicare and Medicaid, he said.

“They have a range of ways for the completely uninsured to pay, usually on sliding fee scale,” he added. “They are much more sensitive to the individual who does not have any money or the ability to pay it back.”

Study authors suggest that there should be broader adoption of the FQHC model of care, which includes comprehensive and preventive primary care, a focus on vulnerable populations such as minorities and the uninsured, consumer participation, and cultural and linguistic sensitivity, among other features.


Shi L, LeBrun-Harris LA, Daly CA, et al.: Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. J Health Care Poor Underserved. 24 (2013): 56–66

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Soda Pop Top

King County health officials say consumption of sugary drinks contributing to obesity among the young


Photo: Alessandro Paiva

Close to a third of high school students, or 26,000 youth, drink soda daily in King County, and 8,000 students drink two or more sodas per day, according to a new “Youth consumption of sugary drinks in King County” report.

Sugary drinks are the largest single source of calories in the U.S. diet and account for almost half of all added sugars that Americans consume.

With 1 in 5 youth in King County is either overweight or obese “reducing the amount of sugary drinks our children consume is a key strategy for improving health,” said Dr. David Fleming, Director & Health Office for Public Health – Seattle & King County.

A person who drinks two 20-ounce regular colas per day consumes 4.7 cups of sugar per week — or 243 cups of sugar per year — from soda alone. The consumption of sugary drinks has been linked to risks for obesity, diabetes, heart disease, stroke, and hypertension.

According to the new “Youth consumption of sugary drinks in King County” Data Watch Report:

  • Two out of three King County middle and high school students report drinking sugary drinks, including sodas, sports drinks or other flavored sweetened drinks, at school.
  • Of those youth who drink sugary drinks at school, 43% bring them from home, 9% get them from friends, 29% buy them at school, and 20% obtain them in other ways
  • Among high school students, daily consumption of at least one soda is highest among American Indian/Alaskan Native youth (40%), Hispanic/Latino youth (39%), Native Hawaiian/ Pacific Islander youth (38%) and African American youth (37%) versus 30% for white, non-Hispanic youth.

Sugary drinks are beverages with added sugars, such as regular sodas (or “pop”), energy drinks, sports drinks, sweetened fruit drinks, and sweetened coffees and teas.

On average, a 20-ounce bottle of regular soda has more than 16 teaspoons of sugar and 240 calories. This is double the total amount of added sugar allowed for an entire day based on a 2,000 calorie diet.

During the last two years as part of Communities Putting Prevention to Work (CPPW), a one-time federal stimulus-fund initiative, King County organizations have been taking steps to decrease access to sugary drinks and offer healthier options, such as water or low-fat milk.

As part of CPPW, the Childhood Obesity Prevention Coalition launched Soda Free Sundays, a community level campaign to take a break from sodas one day a week.  Over 1,000 individuals and 55 organizations took the pledge to go soda free on Sundays.

“This report demonstrates that sugary drink overconsumption continues to be a real problem in King County,” said Victor Colman, Director of the Childhood Obesity Prevention Coalition. “We know that with action at the individual, organizational, and community-wide levels we can see real progress and make healthier beverage choices within reach for everyone.”

Steps families and organizations can take to cut down on sugary drinks:

  • Purchase, serve and enjoy low-sugar options like water, low-fat milk, unsweetened tea and coffee drinks, and small portions (4 ounces or less) of 100% fruit juice.
  • If you do have a sugary drink as an occasional treat, cut calories and save money by ordering a small size and saying “no thanks!” to refills.
  • Ensure easy access to cool, fresh water at work, in organizations that serve kids and in public spaces.
  • Use the King County Board of Health’s Healthy Vending Guidelines to make sure that your vending machines offer the healthiest beverage options
  • .Limit the availability of sugary drinks at your workplace or organization by using the King County Vending Guidelines to identify the types of healthy drinks to make available.

To learn more about sugary drinks and what you can do, visit:

  • Public Health’s sugary drinks webpages, includes new  “10 things parents should know about sugary drinks” and “10 things families and organizations can do to cut down on sugary drinks” fact sheets
  • Soda Free Sundays, a community-wide challenge to take a break from soda and other sugary drinks for just one day out of the week.

Story photo and thumbnail photo courtesy of Alessandro Pavla.

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Tobacco Thumb

Decline in smoking stalls in King County


The decline in the number of adults who smoke in Kind County has stalled, Public Health – Seattle & King County finds in a new report

Today, an estimated 155,000 King County adults continue to be cigarette smokers and an additional 26,000 use smokeless tobacco, according to the county’s new “Tobacco use in King County” Data Watch Report.

Tobacco remains the leading preventable cause of death nationally, and in King County it accounts for 1 in 5 deaths and $343 million annually in health care expenses and lost wages, the report finds.

Other highlights from the report:

  • After a nearly 50% decline from 1996 to 2007, smoking rates among adults flattened in the most recent 5 year period of 2007-2011. About 10% of King County adults smoke, plus an additional 2% use smokeless tobacco products.
  • More than 15,000 students (including 1 in 4 12th graders) used cigarettes or other tobacco products in the past month.
  • Adult smoking rates are highest among African-Americans, low-income residents and lesbian, gay, bisexual and transsexual (LGBT) groups.
  • For youth, the highest smoking rates are among American Indian/Alaska Native, Native Hawaiian/ Pacific Islander and Latino youth.
  • Youth also use alternative tobacco products such as chewing tobacco, snuff, dip, cigars, cigarillos and little cigars – many of which are flavored to taste like fruit, candy, or alcohol.
  • In all, 50% of female and 67% of male tobacco users reported using multiple tobacco types.

Though King County has an overall smoking rate that is among the lowest in the country, the county has the most extreme smoking gap between communities with low smoking rates and those that have high smoking rates of the 15 largest metropolitan counties in the United States.

To learn more, visit:

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Hepatitis Awareness

What you should know about hepatitis


More than 4 million Americans have viral hepatitis and an estimated 85,000 become infected each year, according the U.S. Centers for Disease Control and Prevention (CDC).

In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

  • Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.
  • Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.
  • Vaccines offer protection from hepatitis A and hepatitis B.
  • No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.
  • Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

Local Resources:

What are the symptoms of viral hepatitis?

Symptoms include

  • jaundice, which causes a yellowing of the skin and eyes
  • fatigue
  • abdominal pain
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • low grade fever
  • headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

  • international travelers, particularly those traveling to developing countries
  • people who live with or have sex with an infected person
  • people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely
  • day care children and employees, during outbreaks
  • men who have sex with men
  • users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

  • people who live with or have sexual contact with an infected person
  • men who have sex with men
  • people who have multiple sex partners
  • injection drug users
  • immigrants and children of immigrants from areas with high rates of hepatitis B
  • infants born to infected mothers
  • health care workers
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed
  • international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

  • People most likely to be exposed to the hepatitis C virus are
  • injection drug users
  • people who have sex with an infected person
  • people who have multiple sex partners
  • health care workers
  • infants born to infected women
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced
  • people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

  • people who live with or have sex with a person infected with hepatitis D
  • people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

  • international travelers, particularly those traveling to developing countries
  • people living in areas where hepatitis E outbreaks are common
  • people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179




Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488




Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702




You may also find additional information about this topic by visiting MedlinePlus at

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit Consult your doctor for more information.

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