A nurse is educating a group of assistive personnel about hepatitis transmission routes. Which of the following types of hepatitis are primarily transmitted via the fecal-oral route? (Select all that apply)

Choice A rationale Autoimmune hepatitis is an uncommon, chronic form of liver inflammation caused when the body's immune system mistakenly attacks liver cells (hepatocytes). It is not caused by a virus and therefore has no transmission route; it is an immune disorder of unknown etiology, often treated with corticosteroids and immunosuppressive drugs, and is not transmitted fecal-orally. Choice B rationale Hepatitis B virus (HBV) is transmitted primarily through percutaneous or mucosal exposure to infectious blood or other body fluids, such as during sexual contact, perinatally from mother to child, or via shared needles. It is not transmitted via the fecal-oral route, but through parenteral exposure, and can lead to chronic infection and cirrhosis. Choice C rationale Hepatitis C virus (HCV) is a blood-borne virus, predominantly transmitted through large or repeated percutaneous exposures to infected blood, most commonly via injection drug use (sharing needles or equipment). Transmission via the fecal-oral route is not a mechanism for HCV, as the virus is not primarily shed in feces but is circulating in the blood. Choice D rationale Hepatitis A virus (HAV) is primarily transmitted via the fecal-oral route, which involves the ingestion of contaminated food or water, or through close personal contact with an infected person who has poor hand hygiene. This non-enveloped virus causes an acute infection of the liver that does not progress to chronic disease. Choice E rationale Alcoholic hepatitis is a form of liver inflammation caused by excessive and prolonged consumption of alcohol, a chemical hepatotoxin, not by a transmissible virus. Therefore, it has no transmission route, including the fecal-oral route, and its development is directly dependent on the dose and duration of alcohol intake, not on human contact. Choice F rationale Hepatitis D virus (HDV) is a unique, incomplete RNA virus that requires the presence of Hepatitis B virus (HBV) for replication. It is transmitted in the same ways as HBV—via blood and body fluids (parenterally)—not via the fecal-oral route. HDV infection, when present with HBV, can significantly worsen the severity of liver disease. Choice G rationale Hepatitis E virus (HEV) is primarily transmitted through the fecal-oral route, most commonly via consumption of contaminated water, particularly in regions with poor sanitation, making it an enteric infection like Hepatitis A. Although it is usually acute and self-limiting, it can be severe in pregnant women and immunocompromised individuals. Choice H rationale Toxic hepatitis, also known as drug-induced liver injury, is an inflammation of the liver caused by exposure to various chemicals, herbal supplements, or prescription medications that are toxic to the liver cells. It is not a viral infection and therefore has no transmission route; it depends entirely on exposure to the specific hepatotoxic agent.