Hepatitis by route, not by letter
The alphabet is the wrong sort order. Group these viruses by how they travel and every other row falls into place.
| The enteric pair: A and E | Blood and body fluid: B and D | The percutaneous one: C | |
|---|---|---|---|
| Route | Fecal-oral | Blood, sexual contact, perinatal | Chiefly blood |
| Typical source | Contaminated water, food handled by an infected person, undercooked shellfish for A | Needlesticks, shared injection equipment, unprotected sex, birth to an infected mother | Injection drug use, transfusion before 1992 |
| Incubation | A, roughly two to seven weeks | B, roughly six weeks to six months | Roughly two weeks to six months |
| Chronic carriage | Never | B becomes chronic in a small minority of infected adults and the large majority of infected newborns | Frequently chronic and frequently silent for years |
| Vaccine | A, yes. E, no US-licensed vaccine | Yes for B, and that same vaccine prevents D | None |
| Post-exposure action | Vaccine, with immune globulin for selected patients | For an unvaccinated nurse after a needlestick: hepatitis B immune globulin plus the vaccine series | No immune globulin and no vaccine exists; baseline and follow-up testing is the action |
| Nursing emphasis | Hand hygiene, food and water safety, sanitation | Source control, safe injection practice, newborn prophylaxis at birth | Screening, because it is silent; a leading route into cirrhosis and transplant |
The dependency fact
Hepatitis D cannot infect anyone who does not already carry hepatitis B, because it borrows the B surface coat to enter cells. Preventing B therefore prevents D outright. No separate D vaccine exists and none is needed.
Memory hookVOWELS FROM THE BOWELS. A and E are the vowels, and the vowels travel fecal-oral. Everything else in this family travels by blood.
Watch outhepatitis E carries markedly higher mortality in pregnancy than in the general population. A pregnant patient with jaundice and a recent stay in a region with unsafe drinking water is escalated, not reassured.
Margin notethe enteric pair never turns chronic.
Takeawaygroup by route and every other row falls into place, because the enteric pair never becomes chronic and the bloodborne group is where chronic liver disease comes from.
Standard and contact precaution mechanics → BOOK 04 · P6. Serology marker interpretation → BOOK 07 · P7. Antiviral therapy → BOOK 05 · P8.