July 28 is World Hepatitis Day. Below, please find everything you ever wanted to know about the various forms of this common viral disease.

Words by Daniel Hirsch

World Hepatitis Day is observed every July 28. It’s an occasion to raise awareness about the spread, prevention, and treatment of viral hepatitis.

The World Health Organization (WHO) reports that almost 300 million people live with chronic hepatitis B or C globally. More than 1.3 million people die of either each year, and there are 2 million new cases reported annually. Finally, roughly 4.5 million premature deaths could be prevented by 2030 through education, reduction of stigma, vaccination, testing, and treatment. Given all these stats, hepatitis is a very good thing to know about.

I spoke with DAP Health Director of Infectious Diseases Dr. Shubha Kerkar about what can be done to slow the spread of hepatitis, and why some forms of it are dubbed “the silent killer.” With more than three decades of experience fighting infectious disease, Kerkar is intimate with the complex factors involved in ending pandemics.

Why is hepatitis serious?

Untreated viral hepatitis B or C causes three things: liver failure, liver cirrhosis (permanent liver scarring), and liver cancer. Almost always, the number one reason for liver cancer or liver transplant in the U.S. — up until very recently — was hepatitis C-related cirrhosis. It can also lead to symptoms that go beyond the liver, from fatigue to earlier cardiovascular disease. Untreated, hepatitis B or C can be fatal.

There are many types of hepatitis — A, B, C, D, E — why focus on types B and C?

Since 1982, hepatitis B has been preventable via a vaccine administered to children before they are two years of age. Still, we have 254 million people living with hepatitis B today. There are certain medicines to control it, but it can still lead to liver cancer, and we still don’t have a cure, so vaccination is essential. We need to get more people vaccinated, but people have developed tremendous distrust in vaccines over the last few years, so there are challenges.

Hepatitis C was a bigger pandemic until 2015 or so. We are now rapidly able to cure hepatitis C. The burden went down, but currently, 50 million people still live with hepatitis C. 

So, of these two viruses, C is curable, and B is preventable. That’s the bottom line.

How does hepatitis C spread?

Primarily through contact with infected blood, which means intravenous drug users are at especially high risk. 

However, about 50 to 60% of people who have hepatitis C may not even know it because they’ve never been tested — and there are often no symptoms initially. Over two to four decades, it then slowly scars the liver. Symptoms of liver failure occur when the liver decompensates, and a cure may not save the need for transplant. That’s why it’s known as “the silent killer.”

Because the test was only developed in 1992, hepatitis C has spread all over the world. So regardless of risk factors, baby boomers have a five-fold higher risk of unknowingly having hepatitis C. They need to get tested to see if they have it. Then, we can cure them. 

The other thing about hepatitis C is that you can get reinfected after being treated and cured.

And hepatitis B?

Hepatitis B is transmitted through sexual contact as well as infected blood or bodily fluids.

What can be done to stop the spread?

I have been treating and trying to cure hepatitis C since 1996. From 1996 to 2015, there was a 35 to 45 % cure rate. However, since the newer medications — which are easy to tolerate without any side effects — the cure rate is nearly 100%. So, the easiest part of treating hepatitis C is getting people tested so they know they have it, then linking them to care.

Hepatitis B is preventable via vaccine, yet I do manage several patients who have hepatitis B. It is treatable but prevention is best.

To eliminate hepatitis, we need education, prevention, screening, and linkage to care. DAP Health has been doing a lot of free testing. We also provide harm reduction services so if a patient is struggling with substance use, they can access clean needles.

For both hepatitis B and C, elimination and cure are the goals. Eliminate hep B by vaccination. Eliminate hep C by widespread testing and linkage to care, and cure those who have it with treatment.

The ABCDEs of Hepatitis

While education efforts largely focus on hepatitis B and C, each type has unique transmission methods, symptoms, potential for chronic infection, and prevention strategies. “Hepatitis A can cause severe liver disease, but it’s most often self-limiting,” says DAP Health Medical Director of Specialty Programs Dr. Jason Halperin. “Though if you already have hep B or C, it could be life-threatening.

“Hep D is crazy. It only lives within hep B. It’s a virus that cannot live alone, so folks with chronic hep B are at risk. Hep E is only seen outside of the USA, specifically in sub-Saharan Africa and Southeast Asia. It’s especially difficult during pregnancy.”

Below is a full rundown on each type of hepatitis.

Hepatitis A (HAV)

• Transmission: Fecal-oral route, often through contaminated food or water.
• Symptoms: Acute illness with jaundice, fatigue, abdominal pain, and fever.
• Chronicity: Does not become chronic.
• Prevention: Vaccination and good hygiene.

Hepatitis B (HBV)

• Transmission: Blood, sexual contact, and from mother to child during childbirth.
• Symptoms: Acute and chronic liver disease. Can lead to cirrhosis or liver cancer.
• Chronicity: Can become chronic.
• Prevention: Vaccination.

Hepatitis C (HCV)

• Transmission: Blood, primarily through sharing needles or blood transfusions.
• Symptoms: Often asymptomatic initially, can lead to chronic liver disease.
• Chronicity: Often becomes chronic.
• Prevention: No vaccine but avoid sharing needles and ensure safe blood products.

Hepatitis D (HDV)

• Transmission: Blood, like HBV; requires HBV for replication.
• Symptoms: Like HBV but more severe liver disease.
• Chronicity: Can become chronic.
• Prevention: HBV vaccination (since HDV requires HBV to propagate).

Hepatitis E (HEV)

• Transmission: Fecal-oral route, like HAV, often through contaminated water.
• Symptoms: Acute liver disease with jaundice, fever, and abdominal pain.
• Chronicity: Rarely becomes chronic.
• Prevention: Good sanitation and hygiene practices; vaccination in some regions.