Have you been affected by viral hepatitis? Our network of members can offer advice and support to you and your loved ones.
What is Viral Hepatitis
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, delta and E. These five types are of greatest concern because of the burden of illness and death they cause and their potential for outbreaks and epidemic spread.
REAL STORIES
Together our stories can change the way the world sees viral hepatitis.
What makes hepatitis a global health problem
Every 30 seconds, someone dies from a viral hepatitis-related illness. However, with the existing prevention, testing and treatment services that are available every hepatitis-related death is preventable.
Hepatitis can affect anyone, but it disproportionately affects the people and communities most underserved by health systems.
Different types of viral hepatitis
Hepatitis A
Vaccine: Yes
Treatment: Yes
Cure: Most people make a full recovery
Hepatitis A is an inflammation of the liver caused by the hepatitis A virus. It is spread primarily when an unvaccinated person consumes food or water that contains traces of faeces from someone with hepatitis A. The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene, and oral-anal sex.
Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease, but it can cause debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal. The World Health Organization (WHO) estimates that in 2023, 35,569 people died from hepatitis A worldwide (accounting for 2.6% of the mortality due to viral hepatitis).
Hepatitis A is common in low- and middle-income countries with poor sanitary conditions and hygienic practices. The number of cases is low in high-income countries with good sanitary and hygienic conditions. It may occur among adolescents and adults in high-risk groups, such as people who inject drugs (PWID), men who have sex with men (MSM), people travelling to areas of high endemicity and in isolated populations, such as closed religious groups.
Symptoms
The incubation period of hepatitis A is usually 14 to 28 days.
Symptoms of hepatitis A range from mild to severe and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine, and jaundice (a yellowing of the eyes and skin). Not everyone will have all the symptoms. Adults have signs and symptoms more often than children.
Treatment
There is no specific treatment for hepatitis A. Recovery from symptoms may be slow and can take several weeks or months.
Hepatitis A sometimes relapses, meaning the person who just recovered falls sick again with another acute episode. This is normally followed by recovery.
Prevention
Immunisation is one of the most effective ways to combat hepatitis A. Improved sanitation, food safety and safer sex practices are also key to preventing hepatitis A.
The spread of hepatitis A also can be reduced by:
- adequate supplies of safe drinking water;
- proper disposal of sewage within communities; and
- personal hygiene practices such as regular handwashing before meals and after going to the bathroom.
Hepatitis B
Vaccine: Yes
Treatment: Yes
Cure: In development
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It can be acute (short and severe) or chronic (long term), which puts people at high risk of death from cirrhosis and liver cancer.
Hepatitis B is a major global health problem. The burden is highest in the WHO Pacific Region and the WHO African Region, where 102 million and 64 million people, respectively, are living with chronic hepatitis B. 43 million people are living with hepatitis B in the WHO South-East Asia Region, 16 million in the WHO Eastern Mediterranean Region, 9.7 million in the WHO European Region and 5 million in the WHO Region of the Americas.
Transmission
Hepatitis B is commonly most spread through vertical transmission (from a mother to infant during pregnancy or delivery) or horizontal transmission (exposure to the blood of someone living with hepatitis B). About 95% of chronic hepatitis B cases are acquired during infancy or early childhood.
Hepatitis B is also spread by needlestick injury, tattooing, piercing, and exposure to the blood and body fluids of someone living with hepatitis B, 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 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.
Symptoms
Most people do not experience any symptoms when they acquire hepatitis B. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, feeling very tired, nausea, vomiting, and abdominal pain. When severe, acute hepatitis B can lead to liver failure and death. Although most people recover from acute illness, some people living with chronic hepatitis B will develop progressive liver disease and complications such as cirrhosis and hepatocellular carcinoma (liver cancer), which cause high morbidity and mortality.
Diagnosis and treatment
As of 2024, 27% of all people estimated to be living with hepatitis B were aware of their status, while 4.3% (10 million) of the people living with chronic hepatitis B were on treatment.
Chronic hepatitis B can be treated with oral antiviral medicines. Treatment can slow the progression of cirrhosis, reduce liver cancer cases, and improve long term survival. In the updated WHO 2024 Hepatitis B Guidelines, it is estimated that more than 50% of people living with chronic hepatitis B will require treatment, depending on setting and eligibility criteria.
About 7.4% of people living with HIV are also living with hepatitis B. Tenofovir, which is included in the treatment combinations recommend as first-line therapy for HIV, can also be used to treat hepatitis B.
For more information about the new WHO Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection, please read WHA’s community briefing here.
Prevention
A safe and effective vaccine that offers nearly 100% protection against hepatitis B is available. Preventing hepatitis B averts the development of complications including chronic disease and liver cancer.
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 the hepatitis B vaccine at least 4 weeks apart to complete the vaccination series. Protection lasts at least 20 years and is probably lifelong. WHO does not recommend booster vaccinations for people who have completed the 3-dose vaccination schedule. In addition to infant vaccination, WHO recommends the use of antiviral medicines for the prevention of vertical transmission.
To reduce the risk of transmission, WHO also recommends safer sex practices by using condoms; avoiding sharing needles or any equipment used for injecting drugs, piercing, or tattooing; and getting a hepatitis B vaccine if working in a health care setting.
Hepatitis C
Vaccine: No
Treatment: Not applicable
Cure: Yes
Hepatitis C is a potentially life-threatening illness caused by the hepatitis C virus. It can be both acute (short-term) or chronic (long-term).
About 70% (55–85%) of people who acquire hepatitis C will develop chronic hepatitis C. Of those with chronic hepatitis C, the risk of cirrhosis ranges from 15% to 30% within 20 years.
The highest burden of hepatitis C is in the WHO Eastern Mediterranean Region, with an estimated 12 million people living with hepatitis C. In both the WHO South-East Asia Region and WHO African Region, it is estimated that 9 million people are living with hepatitis C. In the WHO European Region, 7 million people are living with hepatitis C, with 8 million in the WHO Western Pacific Region and 5 million the WHO Region of the Americas.
Transmission
Hepatitis C is a bloodborne virus. It is most commonly transmitted through:
- the reuse or inadequate sterilisation of medical equipment, especially syringes and needles in health care settings;
- the transfusion of unscreened blood and blood products; and
- injection drug use through the sharing of injection equipment.
Hepatitis C also can be acquired through vertical transmission and via sexual practices that lead to exposure to blood (for example, people with multiple sexual partners and among men who have sex with men); however, these modes of transmission are less common.
Hepatitis C is not spread through breast milk, food, water, or casual contact such as hugging, kissing and sharing food or drinks with a person living with hepatitis C.
Symptoms
Most people do not experience any symptoms in the first weeks after acquiring hepatitis C. It can take between two weeks and six months to have symptoms, which may include fever, feeling very tired, decreased appetite, nausea, vomiting, abdominal pain, dark urine, pale faeces, joint pain, and jaundice (yellowing of the skin or eyes).
Diagnosis and treatment
People living with hepatitis C often are diagnosed after they have been living with the disease for years. It usually remains asymptomatic until decades later when symptoms develop secondary to serious liver damage.
Early diagnosis can prevent health problems that may result from chronic hepatitis C and prevent transmission. WHO recommends testing people who may be at increased risk of hepatitis C, including migrants from endemic regions, health care workers, people who inject drugs (PWID), people in prisons, men who have sex with men (MSM), sex workers and people living with HIV.
Direct-acting antivirals (DAAs) can cure more than 95% of people living with hepatitis C. WHO recommends therapy with pan-genotypic DAAs for people over the age of 3 years old living with chronic hepatitis C. The treatment duration is short (usually 8 to 12 weeks), depending on the absence or presence of cirrhosis.
Of the 68 million persons living with hepatitis C globally between 2015 and 2024, an estimated 36% knew their diagnosis, and around 20% (12.5 million) people had been treated with DAAs by the end of 2024.
Prevention
There is no effective vaccine against hepatitis C, so prevention depends on reducing the risk of exposure to it in health care settings and in higher risk populations.
Primary prevention interventions recommended by WHO include:
- safe and appropriate use of health care injections and procedures;
- safe handling and disposal of needles and medical waste;
- harm reduction services for people who inject drugs, such as needle exchange programmes, substance use counselling and use of opiate agonist therapy (OAT);
- testing of donated blood for hepatitis C and other viruses;
- training of health personnel; and
- practicing safe sex by using barrier methods such as condoms.
Hepatitis delta
Vaccine: No (although hepatitis delta only affects people living with hepatitis B which there is a vaccine for)
Treatment: Yes
Cure: No
Hepatitis delta is an inflammation of the liver caused by the hepatitis delta virus, which requires hepatitis B for its replication. Hepatitis delta cannot occur in the absence of hepatitis B. Living with hepatitis B and delta is considered the most severe form of chronic viral hepatitis due to more rapid progression towards hepatocellular carcinoma and liver-related death.
Vaccination against hepatitis B is the only method to prevent hepatitis delta.
Hepatitis delta affects nearly 5% of people globally (about 12 million) who have chronic hepatitis B. It could also explain about 1 in 5 cases of liver disease and liver cancer in people living with hepatitis B.
Transmission
The routes of hepatitis delta transmission, like hepatitis B, occur through broken skin (via injection, tattooing, etc), contact with the blood of someone living with hepatitis delta, or sexual intercourse. Vertical transmission is possible but rare. Vaccination against hepatitis B prevents hepatitis delta and hence expansion of childhood hepatitis B immunisation programmes has resulted in a decline in hepatitis delta incidence worldwide.
People living with chronic hepatitis B are at risk of hepatitis delta. People who are not immune to hepatitis B (either by natural disease or immunisation with the hepatitis B vaccine) are at risk of hepatitis B, which puts them at risk of hepatitis delta.
Those who are more likely to have hepatitis delta include indigenous people, people who inject drugs and people living with hepatitis C virus or HIV. The risk also appears to be potentially higher in recipients of haemodialysis, men who have sex with men (MSM), and commercial sex workers.
Symptoms
Living with both hepatitis B and hepatitis delta can lead to a mild-to-severe hepatitis with signs and symptoms of indistinguishable from those of other types of acute viral hepatitis. These include fever, fatigue, loss of appetite, nausea, vomiting, dark urine, pale-coloured stools, and jaundice (yellow eyes).
Diagnosis and treatment
Hepatitis delta diagnostics are not widely available and there is no standardisation for hepatitis delta RNA assays, which are used to detect active hepatitis delta and for monitoring response to antiviral therapy.
Treatment is available for hepatitis delta, but it tends to give a low rate of response to the treatment. However, the treatment is associated with a lower likelihood of disease progression.
The hepatitis delta treatment landscape is rapidly evolving, with some new options showing favourable results.
Prevention
Prevention services of hepatitis delta should focus on reducing hepatitis B transmission through hepatitis B immunisation, including a timely birth dose vaccine, additional antiviral prophylaxis for eligible pregnant women, blood safety, safe injection practices in health care settings, and harm reduction services with clean needles and syringes. Hepatitis B immunisation does not provide protection against hepatitis delta for those already living with hepatitis B.
Hepatitis E
Vaccine: Not available in all settings
Treatment: Yes
Cure: Most people make a full recovery
Hepatitis E is inflammation of the liver caused by the hepatitis E virus.
It is shed in the stools of people living with hepatitis E and enters the human body through the intestine. It is transmitted mainly through contaminated drinking water. It is usually self-limiting and resolves within 2–6 weeks. Occasionally a serious disease known as fulminant hepatitis (acute liver failure) develops, which can be fatal.
Transmission
Hepatitis E is found worldwide and is common in low- and middle-income countries with limited access to essential water, sanitation, hygiene, and health services. In these areas, hepatitis E occurs both as outbreaks and sporadic cases. The outbreaks usually follow periods of faecal contamination of drinking water supplies and may affect several hundred to thousand people.
Some outbreaks have occurred in areas of conflict and humanitarian emergencies such as war zones and camps for refugees or internally displaced populations, where sanitation and safe water supply pose special challenges.
Symptoms
Symptoms of hepatitis E typically last 1-6 weeks and may include:
- an initial phase of mild fever, reduced appetite, nausea and vomiting lasting for a few days;
- abdominal pain, itching, skin rash, or joint pain;
- jaundice (yellow colour of the skin), dark urine and pale stools; and
- a slightly enlarged, tender liver (hepatomegaly).
Diagnosis and treatment
Diagnosis can often strongly be suspected in appropriate epidemiologic settings, for example when several cases occur in localities in known endemic areas, in settings with risk of water contamination when the disease is more severe in pregnant women or if hepatitis A has been excluded.
Hospitalisation is not generally needed but is required for people with fulminant hepatitis and should be considered for symptomatic pregnant women.
Prevention
Prevention is the most effective approach against hepatitis E. At the population level, transmission of hepatitis E can be reduced by:
- maintaining quality standards for public water supplies; and
- establishing proper disposal systems for human faeces.
On an individual level, the risk can be reduced by:
- maintaining hygienic practices; and
- avoiding consumption of water and ice of unknown purity.
A vaccine to prevent hepatitis E has been developed but is not widely available.
How to get tested for hepatitis
Available testing for hepatitis is different in every country. Unfortunately, hepatitis testing is not often free or easy to access in some countries. To find out more about access to hepatitis testing in your country, please find your local hepatitis organisation here: www.worldhepatitisalliance.org/our-members
Have you been affected by viral hepatitis? Our network of members can offer advice and support to you and your loved ones.
