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Hepatitis is one of those illnesses that most people are aware exists but they do not know much about what it really is. This is why the World Health organisation (WHO) selected 28 July 2020 to bring awareness of the condition to the public and help policy writers identify ways to end the scourge of Hepatitis by committing to the WHO’s plan to end hepatitis across the world by 2030.

Know. Prevent. Test. Treat. Eliminate Hepatitis.

Currently, approximately 290 million people worldwide are living with viral hepatitis without knowing. This is why the theme for this year’s World Hepatitis Day is “Find the Missing Millions”. If we do not find the undiagnosed people and provide them with access to care, millions will continue to suffer, and lives will be lost.

• 325 million people are living with viral hepatitis B and C
• 2,850,000 people were newly infected in 2017
• 80 % of people living with hepatitis lack prevention, testing and treatment
• 6 US$ billion investment needed annually to achieve global elimination targets by 2030

What is Hepatitis?

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. One of these includes autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol.

There are 2 types of hepatitis:

1. Non-viral Hepatitis

Non-viral hepatitis is an inflammation of the liver that can cause scarring on the liver (cirrhosis), liver cancer, liver failure and death and it is three times more common in women than in men.

Key facts: Non-viral Hepatitis

• Toxic hepatitis is caused by chemicals, drugs (prescription and over-the-counter) and nutritional supplements.
• Alcoholic hepatitis is caused by drinking too much alcohol, which harms the liver. See a doctor if you have symptoms of alcoholic hepatitis or if you can’t control your drinking. Your doctor can help you find ways to stop.
• Autoimmune hepatitis occurs when the immune system mistakes the liver as a harmful object and begins attacking it. The immune system can attack the liver for unknown reasons, causing inflammation, liver scarring, liver cancer and liver failure. Some diseases and certain toxic substances and drugs can cause this to happen.
• To treat your symptoms, your doctor may prescribe corticosteroids to reduce liver inflammation, or you may need to be treated in a hospital. If you are diagnosed with alcoholic hepatitis, you must stop drinking completely to keep the disease from getting worse or causing death.
• Other treatments include stopping exposure to the substance that caused it, taking medication and in extreme cases, receiving a liver transplant

2. Viral Hepatitis

Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.

Key facts: Hepatitis A

• Hepatitis A is a viral liver disease that can cause mild to severe illness.
• The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.
• Almost everyone recovers fully from hepatitis A with a lifelong immunity. However, a very small proportion of people infected with hepatitis A could die from fulminant hepatitis.
• WHO estimates that hepatitis A caused approximately 7 134 deaths in 2016 (accounting for 0.5% of the mortality due to viral hepatitis).
• The risk of hepatitis A infection is associated with a lack of safe water, and poor sanitation and hygiene (such as dirty hands).
• In countries where the risk of infection from food or water is low, there are outbreaks among men who have sex with men (MSM) and persons who inject drugs (PWIDs).
• Epidemics can be prolonged and cause substantial economic loss.
• A safe and effective vaccine is available to prevent hepatitis A.
• Safe water supply, food safety, improved sanitation, hand washing and the hepatitis A vaccine are the most effective ways to combat the disease. Persons at high risk, such as travellers to countries with high levels of infection, MSM and PWIDs can get vaccinated.

Key facts: Hepatitis B

• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
• The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids.
• WHO estimates that in 2015, 257 million people were living with chronic hepatitis B infection (defined as hepatitis B surface antigen positive).
• In 2015, hepatitis B resulted in an estimated 887 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (i.e. primary liver cancer).
• As of 2016, 27 million people (10.5% of all people estimated to be living with hepatitis B) were aware of their infection, while 4.5 million (16.7%) of the people diagnosed were on treatment.
• Hepatitis B can be prevented by vaccines that are safe, available and effective.

Key facts: Hepatitis C

• Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
• Hepatitis C is a major cause of liver cancer.
• The hepatitis C virus is a bloodborne virus: the most common modes of infection are through exposure to small quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood.
• Globally, an estimated 71 million people have chronic hepatitis C virus infection.
• A significant number of those who are chronically infected will develop cirrhosis or liver cancer.
• WHO estimated that in 2016, approximately 399 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).
• Antiviral medicines can cure more than 95% of persons with hepatitis C infection, thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment is low.
• There is currently no effective vaccine against hepatitis C; however, research in this area is ongoing.

Key facts: Hepatitis D

• Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. HDV infection occurs only simultaneously or as super-infection with HBV.
• The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids.
• Direct transmission from mother to an embryo, fetus, or baby during pregnancy is rare.
• Hepatitis D virus (HDV) affects globally nearly 5% of people who have a chronic infection with hepatitis B virus (HBV).
• Several geographical hotspots of high prevalence of HDV infection exist, including Mongolia, the Republic of Moldova, and countries in Western and Middle Africa.
• Populations that are more likely to have HBV and HDV co-infection include people who inject drugs, indigenous populations and recipients of hemodialysis.
• Worldwide, the overall number of HDV infection has decreased since 1980s. This trend is mainly due to a successful global HBV vaccination programme.
• HDV-HBV co-infection is considered the most severe form of chronic viral hepatitis due to more rapid progression towards liver-related death and hepatocellular carcinoma.
• Currently, treatment success rates are generally low.
• Hepatitis D infection can be prevented by hepatitis B immunization.

Key facts: Hepatitis E

• Hepatitis E is a liver disease caused by infection with a virus known as hepatitis E virus (HEV).
• Every year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E (1).
• WHO estimates that hepatitis E caused approximately 44 000 deaths in 2015 (accounting for 3.3% of the mortality due to viral hepatitis).
• The virus is transmitted via the fecal-oral route, principally via contaminated water.
• Hepatitis E is found worldwide, but the disease is most common in East and South Asia.
• A vaccine to prevent hepatitis E virus infection has been developed and is licensed in China, but is not yet available elsewhere.

Common symptoms hepatitis

How hepatitis is diagnosed

If you think that you might have been exposed to hepatitis, make sure that you visit your health practitioner. Depending on the kind of Hepatitis that you may have been exposed to, the medical professional will do one or more of the following the following to diagnose the condition:

• History and physical exam
• Liver function tests
• Other blood tests
• Ultrasound
• Liver biopsy

 Tips to prevent hepatitis

Practicing good hygiene is key to avoid contracting hepatitis A and E. If you’re traveling to a developing country, you should avoid:

• local water
• ice
• raw or undercooked shellfish and oysters
• raw fruit and vegetables

 Hepatitis B, C, and D contracted through contaminated blood can be prevented by:

• not sharing drug needles
• not sharing razors
• not using someone else’s toothbrush
• not touching spilled blood

Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection.

 The bad end of the spectrum

When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:

• bleeding disorders
• a build-up of fluid in your abdomen, known as ascites
• increased blood pressure in portal veins that enter your liver, known as portal hypertension
• kidney failure
• hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the build-up of toxins, like ammonia, that affect brain function
• hepatocellular carcinoma, which is a form of liver cancer
• death

 What Can I do to get involved?

Know. Prevent. Test. Treat. Eliminate Hepatitis.

Click here to get involved in World Hepatitis day activities in 2020

Click here to receive ready-to-share #WorldHepatitisDay social media posts in your mailbox

Click here to urge your government to commit to the elimination of Hepatitis by 2030

For more information, visit the World Hepatitis Day website or the World Health Organisation