Hepatitis is the second most leading cause of infection-related deaths worldwide, and people are nine times more likely to be infected with hepatitis than with HIV. Although hepatitis is a major global public health concern, it was only prioritized after WHO identified specific action points that will help in the prevention of viral hepatitis as part of the "2030 Agenda for Sustainable Development Goals".
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According to the World Health Organization (WHO), hepatitis can be eliminated completely by the year 2030 if there is an investment of $6 billion per year.
What is hepatitis?
Hepatitis is characterized by liver inflammation that can sometimes lead to fibrosis, cirrhosis, and even liver cancer. Although the primary causative factor is a viral infection, hepatitis can also develop due to exposure to toxic substances (alcohol, drugs, etc.) and autoimmune diseases.
There are five types of hepatitis viruses, namely A, B, C, D, and E. Of them, types A and E are generally transmitted through contaminated water or food, whereas types B, C, and D are transmitted through parenteral contact with infected body fluids.
Hepatitis A and E are typically characterized by mild self-limiting infections, whereas hepatitis B and C infections are chronic in nature, which often leads to liver cirrhosis and cancer.
What is the prevalence of hepatitis?
Viral hepatitis causes approximately 1.4 million deaths every year. Hepatitis B and C viruses cause about 90% of these deaths, while the other hepatitis viruses cause the remaining 10% of the fatalities. Hepatitis B is one of the most severe and common infectious diseases worldwide. About 1/3rd of the global population has been infected with the hepatitis B virus.
According to global estimates, chronic hepatitis C infection affects about 71 million people and puts them at risk of developing liver cirrhosis as well as liver cancer.
According to the WHO, hepatitis is highly preventable, treatable, and curable, particularly in the case of hepatitis C.
Hepatitis A is mainly transmitted from person to person through the fecal-oral route or due to the consumption of contaminated food or water. Thus, to avoid exposure to the hepatitis A virus, it is important to wash the hands thoroughly after using the restroom or after exposure to blood, stool, and other body fluids of infected persons.
It is also important to avoid the consumption of unclean water, raw or undercooked foods, street foods, and dairy products. The best way to prevent hepatitis A is to get vaccinated. All children who are older than one year should receive the vaccine. The protection against the virus starts four weeks after receiving the first dose of vaccine, and protection usually continues for at least 20 years.
Exposure to infected blood, semen, or other body fluids is the primary way of hepatitis B transmission. Mother to newborn transmission can also occur at the time of birth. Hepatitis B infection can be either acute or chronic, depending on the age of infection. In infants, the risk of the infection becoming chronic is 90%, whereas in adults the risk is only 2 – 6%.
In order to avoid exposure to infected blood or other body fluids, it is important not to share personal items (razors, toothbrushes, etc.) and drug-injection tools (needles, syringe, etc.). It is also important to avoid unprotected sex as the virus can be transmitted through semen.
The best way to prevent hepatitis B is to get vaccinated. In general, the vaccination is done through 3 intramuscular injections wherein the second and third doses are given 1 and 6 months after the first dose, respectively. Infants who receive the vaccine at >6 months of age will usually have protection for at least 30 years.
Hepatitis C virus is most commonly transmitted via exposure to infected blood. The infection eventually becomes chronic in about 70 – 85% of people. Chronic hepatitis C infection can be life-threatening. Unfortunately, there is no vaccine available for hepatitis C.
The best way to prevent hepatitis C is to avoid habits that can increase the risk of disease transmission, such as sharing drug-injection tools.
Hepatitis D is a relatively uncommon liver infection that is transmitted through mucosal contact with infectious blood. It occurs only in people living with hepatitis B, as the hepatitis D virus requires the help of the hepatitis B virus for replication inside the host cell.
Although there is no vaccine for hepatitis D, the infection can be prevented through hepatitis B vaccination.
Hepatitis E is usually transmitted through contaminated water or food. The virus does not cause any chronic infection, and it is most common in developing countries. There is no FDA-approved vaccine available for hepatitis E. The best way to prevent the disease is to avoid the consumption of contaminated food or water.
WHO. 2019. World Hepatitis Day. https://www.who.int/campaigns/world-hepatitis-day/2019
WHO. 2019. What is Hepatitis? www.who.int/.../
Medline Plus. 2017. Preventing Hepatitis A. https://medlineplus.gov/ency/patientinstructions/000422.htm
Medline Plus. 2017. Preventing Hepatitis B or C. https://medlineplus.gov/ency/patientinstructions/000401.htm
Centers for Disease Control and Prevention. 2019. Viral Hepatitis. https://www.cdc.gov/hepatitis/index.htm
Meryem Jefferies, et al. 2018. Update on global epidemiology of viral hepatitis and preventive strategies. World J Clin Cases. https://doi.org/10.12998/wjcc.v6.i13.589