The invisible disease hiding in plain sight

Some diseases announce themselves early. Others creep up subtly. Hepatitis B and C can damage the liver before symptoms appear, leaving people unaware they are living with the disease until serious complications develop, meaning hepatitis is often invisible; that is, unless you voluntarily test for the virus.¹

The short version: the basic ABCs of hepatitis:

There are five recognised types of viral hepatitis: hepatitis A, B, C, D and E. Each differs in how it is transmitted and managed; hepatitis B and C are responsible for the greatest burden of chronic liver disease worldwide. Hepatitis D only occurs alongside hepatitis B, and hepatitis A and E are generally short-term infections. However, hepatitis E can pose severe risks during pregnancy.2

Hepatitis B is a viral infection that affects the liver and, though it can be prevented through vaccination, it remains a major global health challenge. Some people recover completely, but others develop a long-term or chronic infection that can lead to serious complications like liver cirrhosis and liver cancer.3

Why testing matters

“Okay, but why should I go for a test?”

Here’s where it’s worth pausing to consider that viral hepatitis affects over 300 million people globally. Around 2.7 million of those are in South Africa. But most people are not diagnosed or getting the treatment they need. Every day, 3,500 people die from liver disease caused by viral hepatitis worldwide. The burden is greatest in low- and middle-income countries, particularly in Africa, where an estimated 65 million people are living with chronic hepatitis B.4

The good news is that hepatitis B can be prevented through vaccination, and a healthcare provider near you will order a blood test panel that checks for specific viral proteins (antigens) and immune system proteins (antibodies). This simple blood draw usually takes less than five minutes and requires no special preparation.

The World Health Organization recommends that every child receive three doses of the hepatitis B vaccine, with the first dose ideally given within 24 hours of birth.4 Here, in South Africa, hepatitis B vaccination has been part of the national childhood immunisation programme since 1995, and infants routinely receive three doses during their first few months of life, with an additional birth dose recommended for babies born to mothers known to be living with hepatitis B.4

South Africa is not starting from scratch

When a disease can remain undetected for years, early diagnosis becomes one of the most powerful tools available. The sooner hepatitis is identified, the sooner people can access appropriate care and treatment, reducing the risk of serious liver disease and improving long-term health outcomes.¹

South Africa is not starting from scratch. Years of investment in molecular diagnostic infrastructure for HIV have created sophisticated laboratory networks capable of supporting hepatitis testing. Rather than building entirely new systems, we should make better use of those already in place by integrating hepatitis testing, where appropriate, into routine healthcare.6

World Hepatitis Day on 28 July should stand out as a reminder that eliminating hepatitis as a public health threat will depend on more than awareness alone. It requires making testing easier to access, identifying people earlier in the course of the disease and ensuring diagnosis becomes a routine part of healthcare conversations, particularly for those at increased risk.

And it can be done. We can make the invisible visible by building on what already works. Countries around the world have demonstrated that meaningful progress is possible when governments, healthcare providers and industry work towards a common goal.

Lessons from Egypt

Egypt's national hepatitis C programme is a fine example. By combining political commitment, large-scale screening, diagnosis and access to treatment, the country screened millions of people and dramatically reduced the burden of hepatitis C. While every healthcare system is different, one lesson stands out: finding people earlier changes outcomes.7

The challenge is not that hepatitis cannot be found. It is that too many people are only diagnosed after the disease has already caused harm. Earlier diagnosis gives healthcare professionals more time to intervene, gives patients a better chance of successful treatment and helps health systems prevent avoidable illness rather than simply responding to it.

For a disease that often goes unnoticed until significant damage has already been done, finding it earlier may be the simplest way to change the story. We can make this invisible disease visible. One voluntary test is all it takes for peace of mind.

Have you been tested for hepatitis yet?

References

1. https://www.cdc.gov/hepatitis-b/about/index.html

2. https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b--c

3. South African Liver Disease Association (SOLDA). Viral Hepatitis in South Africa.https://soldasa.co.za/

4. https://www.cdc.gov/hepatitis/global/index.html

5. https://www.worldbank.org/en/news/feature/2024/04/05/how-egypt-won-its-battle-against-hepatitis-c

6. https://pmc.ncbi.nlm.nih.gov/articles/PMC11624778/

7. https://www.hepcoalition.org/en/learn/care/article/hepatitis-c-elimination-in-egypt-story-of-success