The current global burden of viral hepatitis, as per the 2024 World Health Organisation (WHO) Global Hepatitis report, estimates 240-million people with chronic hepatitis B and 47-million with hepatitis C infections.
About 1.1-million people die every year due to liver cancer and chronic liver disease because of these infections.
The WHO AFRO region is significantly burdened with 64-million people living with hepatitis B and 7-million with hepatitis C. About 1-million new infections occur every year, most of these occurring in the WHO AFRO region. Given this, sub-Saharan Africa has become the new global epicentre of hepatitis B.
In 2016, the WHO adopted a global health sector strategy to eliminate viral hepatitis by 2030. Almost all member states supported this plan. The plan was premised on several key simple interventions that would produce the required elimination targets by 2030. Unfortunately, this has not happened despite all the tools being available to achieve these outcomes.
World Hepatitis Day, celebrated on July 28 every year since 2010, commemorates the birthday of Dr Barry Blumberg, who discovered hepatitis B in 1965. For this, he was awarded the Nobel Prize in physiology and medicine in 1976.
Dr Blumberg’s discovery led to the development of a blood test that immediately prevented hepatitis B transmission through blood transfusions and ultimately to the development of a highly effective vaccine in 1980.
It is estimated that Dr Blumberg’s discovery has ultimately prevented 40-million deaths globally. For this reason, his birth date is associated with World Hepatitis Day.
Hepatitis B is fully vaccine-preventable. It is for this reason that we vaccinate children to prevent them from acquiring the virus in early childhood, the commonest time this virus is acquired in sub-Saharan Africa.
In addition, highly effective therapy in the form of a pill taken daily (tenofovir) in those already chronically infected can prevent people from developing cirrhosis of the liver and reduce the risk of liver cancer.
Hepatitis B accounts for more than two-thirds of liver cancer in Africa. Liver cancer is the third most common cancer in men in Africa and the fourth most frequent cancer in women.
Since 2014, highly effective therapy in the form of a pill taken once a day for 12 weeks has cured almost 100% of people with chronic hepatitis C virus infection.
Most new infections occur in people who inject drugs, with older people in the population previously infected through blood transfusions before 1992.
Hepatitis B in South Africa is endemic, with a prevalence of 6%, representing 3.6-million people living with hepatitis B, most unaware of their infection. The prevalence of hepatitis C is about 1%, accounting for 900,000 infections.
Unfortunately, the key problem is that infections are silent, and people manifest symptoms only once their livers are very sick. Diagnosing people before this happens is crucial to preventing these complications. South Africa is not doing well in meeting elimination targets.
For hepatitis B, all pregnant women are screened for hepatitis B, and all babies receive a birth dose of the hepatitis B vaccine, plus additional hepatitis B vaccine shots. Where appropriate, mothers may need antiviral therapy during pregnancy as an additional measure to prevent mother-to-child transmission of hepatitis B.
With this care package, perinatal transmission approaches 0%. Our current policy is to screen all mothers and do targeted hepatitis B birth-dose vaccinations. However, this policy is not being uniformly implemented.
In addition, we have no recommended screening for the adult population for hepatitis B, so identifying people with undiagnosed chronic infection is limited.
Equally, we have no national testing routine for hepatitis C. All those at risk should be screened, for example, anybody who has had a blood transfusion before 1992 and anybody who has ever used injectable drugs. If there is any uncertainty, hepatitis C screening should be performed.
For both hepatitis B and C, it involves a simple blood test that can be done through a laboratory or as a finger-prick point-of-care test.
Identifying those infected allows them to access the relevant treatment. A clear elimination metric is that chronic hepatitis B rates in children below five years should be 0.1%. Current data suggests South Africa is at 1.2%.
Overall, based on current metrics, we are not performing optimally and will not meet elimination targets by 2030.
We need to roll up our sleeves, require political will and commitment, and put the national viral hepatitis elimination plan into action. All the tools are available, and importantly, cost-effective.
We should break down all these barriers to achieving hepatitis elimination. It’s time for action!
- Prof Sonderup is a hepatologist and head of the UCT Division of Hepatology based at the University of Cape Town and Groote Schuur Hospital.
