Dr. Sanjay K Yadav 

Health TV Online| Kathmandu : We have only one life and one liver, hepatitis threatens both. On July 28, World Hepatitis Day honours Dr. Baruch Blumberg, who discovered the hepatitis B virus and developed its vaccine.

The theme for 2025 : Hepatitis: Let’s Break It Down calls for urgent action to dismantle the financial, social and systemic barriers – including stigma – that stand in the way of hepatitis elimination and liver cancer prevention.

Chronic hepatitis B and C silently cause liver damage and cancer – despite them being preventable, treatable, and, in the case of hepatitis C, curable. The theme emphasizes the need to simplify, scale up, and integrate hepatitis services – vaccination, safe injection practices, harm reduction and especially testing and treatment – into national health systems.

We commemorate World Hepatitis Day by raising awareness about viral hepatitis. With almost 300 million individuals living with hepatitis B and C worldwide, it is so important to bring awareness to this preventable and treatable disease. The campaign is a reminder that we must act now to expand access, integrate care, and end hepatitis as a public health problem by 2030.

Key Messages for World Hepatitis Day

The liver performs over 500 essential functions to keep us alive, making its protection vital. Yet, deaths from viral hepatitis are rising, with 304 million people living with chronic infections and 6,000 new cases reported daily. Every 30 seconds, one person dies from hepatitis — a total of 3,500 lives lost each day. Globally, millions remain undiagnosed and untreated, as symptoms often appear only in the advanced stages.

Most hepatitis-related infections and deaths are preventable through early diagnosis, treatment, and universal hepatitis B vaccination for pregnant women and children. However, in 2022, only 45% of newborns received the birth dose within 24 hours. It is time to act – by prioritizing testing, treatment, and vaccination – to achieve a hepatitis-free world by 2030.

The four keyways to keep healthy liver and Healthy Life are

Maintaining a healthy liver is essential for a healthy life, as it supports over 500 vital functions and protects key organs including the heart, lungs, kidneys, and brain. Key steps include knowing your hepatitis status and seeking timely treatment, ensuring universal hepatitis B vaccination for pregnant women and children, reducing alcohol intake, maintaining a healthy weight through daily exercise, eating a balanced diet rich in green vegetables and low in fat and carbs, and managing conditions like hypertension and diabetes.

Most hepatitis-related infections and deaths are preventable through early diagnosis, treatment, and universal hepatitis B vaccination for pregnant women and children. However, in 2022, only 45% of newborns received the birth dose within 24 hours. It is time to act – by prioritizing testing, treatment, and vaccination – to achieve a hepatitis-free world by 2030.

Hepatitis remains a major global health threat because it is often a silent infection, with symptoms appearing only in advanced stages. Among the five types (A–E), hepatitis B and C are the most dangerous, responsible for 6,000 new infections and 3,500 deaths daily — that’s one death every 30 seconds. Over one million people die of hepatitis each year, and more than 8,000 new chronic infections occur daily. Alarmingly, if current trends continue, hepatitis could surpass malaria, tuberculosis, and HIV/AIDS as the leading cause of infectious disease deaths by 2040 — despite the fact that most of these deaths are preventable through existing testing, treatment, and vaccination services.

Globally, there is a substantial number of undiagnosed and untreated people living with hepatitis. This must change.

• Most people discover they have hepatitis B or C after many years of silent infection, and only when they develop serious liver disease like liver cirrhosis or liver cancer.
• Only 10% of people with chronic hepatitis B are diagnosed. Only 22% of those receive treatment – that is just 2% of the total global health burden.
• Only 21% of people with hepatitis C are diagnosed. 62% of those diagnosed receive treatment to cure them – just 13% of the total global health burden.

 What is hepatitis?

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. The other causes are alcohol, drugs, obesity etc. There are five main hepatitis viruses, referred to as type A,B,C,D,E. If untreated, the viral hepatitis can lead to advanced liver disease like Liver cirrhosis, Liver Cancer.

Hepatitis B Virus Infection

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at substantial risk of death from cirrhosis and liver cancer.

A safe and effective vaccine that offers 98% to 100% protection against hepatitis B is available. Preventing hepatitis B infection averts the development of complications including chronic disease and liver cancer.

Transmission

In highly endemic areas, hepatitis B is most spread from mother to child at birth (perinatal transmission) or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is common in infants infected from their mothers or before the age of 5 years.

Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal, and seminal fluids. Transmission of the virus may also occur through the reuse of contaminated needles and syringes or sharp objects either in health care settings, in the community or among persons who inject drugs. Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.

Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. This is the basis for strengthening and prioritizing infant and childhood vaccination.

The incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially when transmitted in infancy or childhood.

Symptoms

Most people do not experience any symptoms when newly infected. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People with acute hepatitis can develop acute liver failure, which can lead to death. Among the long-term complications of HBV infections, a subset of persons develops advanced liver diseases such as cirrhosis and hepatocellular carcinoma, which cause high morbidity and mortality.

Treatment

There is no specific treatment for acute hepatitis B. WHO recommends the use of oral treatments (tenofovir or entecavir) as the most potent drugs to suppress hepatitis B virus. Most people who start hepatitis B treatment must continue it for life.

Prevention

World Health Organization (WHO) recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours, followed by 2 or 3 doses of hepatitis B vaccine at least 4 weeks apart to complete the vaccination series. Protection lasts at least 20 years and is lifelong. It does not recommend booster vaccinations for persons who have completed the 3-dose vaccination schedule.

Hepatitis C Virus Infection

Hepatitis c is a viral infection that affects liver. It is the leading cause of Liver Cirrhosis, Liver cancer leading to Liver transplant.

Globally estimated 58 million people have HCV infection with 1.5 million new infection every year. Like Hepatitis B infection, the hepatitis C also spread through contact with infected blood and body fluids. Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice, dark urine.

Acute Hepatitis C infections are usually asymptomatic and resolve spontaneously in around 30% (15-45%) of cases. The remaining 70% (55-85%) person will develop chronic HCV infection. Of those chronic HCV infections, the risk of cirrhosis is from 15 to 30% within 20 years.

Hepatitis C infection can be diagnosed with blood test like HCV antibody and HCV RNA level. WHO recommends all adults should be test for HCV infection once. There are highly effective oral medicines are available for HCV treatments which can cure more than 95% persons with HCV infections. There is no effective vaccine against HCV. The best way to prevent disease is to avoid contact with virus.

Hepatitis A and E

Hepatitis A and E usually cause acute viral hepatitis that typically resolves on its own over time. In rare cases, they can lead to acute liver failure, which may result in death or require an urgent liver transplant. These viruses are transmitted through the fecal-oral route, mainly via contaminated food or water. Hepatitis E can pose serious risks during pregnancy. An effective vaccine is available for hepatitis A.

(Dr Yadav is Senior Consultant HPB and Liver Transplant Surgeon.)