What is it?
- Hepatitis B and C are two virus diseases of the liver that together kill an estimated 1.5 million people annually, a number comparable with HIV/Aids and tuberculosis. Hepatitis has generally received less attention, however, in part because it is less visible and because it kills slowly, over a period of many years, usually through liver cirrhosis and/or liver cancer.
- Lately, however, both diseases have risen on political agendas, and a lot of work is underway to reduce the death toll through broader use of vaccination (for hepatitis B) and drugs (for hepatitis C).
- There is also hepatitis A, D, and E; this fact sheet focuses on B and C because they are by far the most lethal.
What are the symptoms?
- Hepatitis B begins with an ‘acute infection’ that causes no symptoms at all in most people; some people have yellowing of the skin and eyes (jaundice), dark urine, fatigue, nausea, vomiting and abdominal pain. In rare cases, acute hepatitis leads to liver failure, which can be fatal.
- Most people clear the infection, but some develop a ‘chronic’ hepatitis infection, which means the virus keeps living inside the body. This happens in only 5% of healthy adults, but in 30%-50% of children infected before age 6, and 80%-90% of infants infected in the first year of life. Of patients with a chronic infection, 20%-30% will develop liver cirrhosis, a condition in which the liver slowly deteriorates, and/or liver cancer. These conditions are often fatal.
- The picture is similar for hepatitis C. In most people, the acute infection causes no symptoms, or only mild ones. Some patients then clear the infection, but between 55% and 85% move on to chronic infection. Of those, between 15% and 30% will develop liver cirrhosis, and some will get cancer.
How do they spread?
- Hepatitis B spreads much the same way as HIV – through blood and bodily fluids – but hepatitis B is many times more infectious. In developing countries where hepatitis B is widespread, common infection routes include transmission from mother to baby during birth; transmission from one person to the other via blood contact (for instance when children play together); and through transfusions of blood that hasn’t been screened for the virus and other unsafe medical procedures.
- In rich countries, where hepatitis B is less common, sharing needles and sexual intercourse are the most common infection routes.
- Hepatitis C spreads primarily through contaminated blood. In western countries, most people get infected through the sharing of drug injection needles. In the developing world, blood transfusions and other unsafe medical practices are the main routes of transmission. It’s not entirely clear if hepatitis C can spread during sex, but if it happens, it’s probably quite rare.
- An estimated 240 million people around the world have a chronic hepatitis B infection; 130 million to 150 million have chronic hepatitis C.
How are they treated?
- There is no specific treatment for acute hepatitis B. In the chronic stage, a combination of antiviral drugs can suppress the virus and limit liver damage. But the drugs don’t get rid of the virus altogether, so they have to be taken for life.
- For hepatitis C, a new generation of drugs called direct antiviral agents can completely cure as many as 90% of all patients (and prevent liver cirrhosis and liver cancer), usually in 12 weeks and without severe side effects. These drugs are very expensive however; although they are generally sold at lower prices in developing countries, they are still out of reach for many patients.
- The problem is that more than 90% of people with a chronic hepatitis B or C infection don’t know they are infected, and as a result don’t seek treatment. That’s why more widespread testing, and getting therapy for those who are infected, is a global priority.
- A liver transplant can save the life of a patient with severe cirrhosis, but this is a very costly operation that is not available in many countries.
How can they be prevented?
- A safe and effective vaccine for hepatitis B has been available since 1982; it probably protects for life. Most countries have added the vaccine to their standard vaccination schedules for infants, which has already strongly reduced the number of children that become infected. The vaccine is recommended for other groups at risk as well, such as the HIV-infected, people who inject drugs, men who have sex with men, and people who receive multiple blood transfusions.
- There is no vaccine for hepatitis C yet.
- For both hepatitis B and C, infections can be brought down by screening blood and blood products for the virus, and improving the safety of injections and other medical procedures.
What’s the outlook?
- The number of people who become infected with hepatitis B is dropping, and will likely continue to do so, thanks to vaccination. What’s needed are better drugs that will help eliminate the virus in the hundreds of millions of people who already have it.
- With hepatitis C, it’s the other way around: There is no vaccine yet, but drugs can cure the disease in most people. If these treatments become more widely available, especially in developing countries, the death toll will fall. Hepatitis C vaccines, currently under development, could help limit the number of new cases.
- Both diseases deserve more attention as major killers, and testing should become more widespread. WHO is trying to raise awareness, for instance through World Hepatitis Day, 28 July.
A Hepatitis C Toolbox for Journalists, including lots of information about treatment, developed by the World Federation of Science Journalists.