How to prevent and detect hepatitis

Viral hepatitis is a group of liver infections that can, for the most part, be prevented and detected in time. The short answer for protecting yourself has two parts: on one hand, get vaccinated against hepatitis A and hepatitis B, keep up good hygiene and adopt safe practices; on the other, get the blood test that looks for hepatitis B and hepatitis C at least once in your life, even if you feel perfectly well.

This double message, prevent and detect, sums up the current strategy against hepatitis. Prevention stops new infections, and early detection makes it possible to treat those already infected before the virus damages the liver. Both are pieces of the goal set by the World Health Organization (WHO): to eliminate viral hepatitis as a public health threat by 2030.

Why prevent and detect?

There are five main types of viral hepatitis (A, B, C, D and E), and they do not all behave the same way. Hepatitis A and E spread through contaminated water or food and almost always resolve on their own. Hepatitis B, C and D spread through blood and body fluids, and these are the ones that can become chronic and, over the years, lead to cirrhosis and liver cancer.

The problem with chronic hepatitis is that it is silent: it causes no symptoms for years or decades while the liver is damaged without the person knowing it. That is why waiting until you feel unwell is not enough. It makes sense to prevent the types that have a vaccine and to actively look for the ones that may already be present.

Prevention: vaccines

Vaccination is the most effective prevention tool, and it exists for two of the viral hepatitis types.

• Hepatitis A vaccine. It is safe and highly effective, with long-lasting protection. It is especially recommended for people with chronic liver disease of any cause, travelers to areas where the virus circulates widely, men who have sex with men, and people who use drugs.
• Hepatitis B vaccine. It protects more than 95% of people and was the first vaccine shown to prevent a human cancer, the liver cancer linked to this virus. In Chile it is part of the National Immunization Program and is given universally in childhood, with a dose in the first hours of life. A growing number of countries also recommend vaccinating all adults up to age 59 without assessing risk factors, in order to close the gap for those who grew up without the vaccine.

One key point: the hepatitis B vaccine also protects against hepatitis D. The D virus can only infect someone who already has hepatitis B, so anyone immune to B is also protected against D. There is no general-use vaccine against hepatitis C or hepatitis E in our setting.

Prevention: hygiene and safe water

Hepatitis A and E spread by the fecal-oral route, that is, by swallowing water or food contaminated with the virus. Against them, sanitary measures are the first line of defense:

• Safe drinking water and proper handling of sewage.
• Frequent handwashing, especially after using the bathroom and before cooking or eating.
• Food hygiene, with particular care with raw or undercooked shellfish and vegetables that may have been irrigated with sewage-contaminated water.

In Chile, improvements in drinking water and sanitation greatly reduced the circulation of hepatitis A. That same improvement has a less visible effect: because fewer people are infected in childhood, more adults remain susceptible, and in them the disease tends to be more severe, which reinforces the value of the vaccine.

Prevention: safe practices

Hepatitis B, C and D spread through contact with blood and, in the case of B, also sexually. Preventing them means avoiding exposure:

• Do not share needles or syringes, or any equipment used to inject drugs. This is currently the main route of hepatitis C transmission.
• Do not share personal items that may carry traces of blood, such as razors, nail clippers or toothbrushes.
• Practice safe sex, using condoms, particularly with new or multiple partners.
• Tattoos and piercings only at places that use sterile, single-use equipment.

Transmission through transfusions is now practically nonexistent in Chile, because all donated blood is tested.

Prevention in pregnancy

Every pregnant woman should be tested for hepatitis B (HBsAg). Identifying carrier mothers makes it possible to protect the newborn, who should receive, in the first hours of life, the vaccine together with hepatitis B immunoglobulin. This combination prevents the great majority of mother-to-child transmissions, a particularly important route because a newborn who is infected has a very high risk of developing chronic hepatitis. Testing for hepatitis C in each pregnancy is also recommended.

Detection: a blood test, at least once in your life

This is the most important shift in approach of recent years. For a long time, hepatitis testing was offered only to people with known risk factors. That criterion left out too many infected people, because many do not recall or recognize any risk factor. Current recommendations are simpler and broader:

• Hepatitis C: an anti-HCV antibody test at least once in your life for all adults. In the United States, the Preventive Services Task Force (USPSTF) recommends screening all adults aged 18 to 79. If the antibody is positive, it is confirmed with a viral load test (HCV RNA), which shows whether the infection is active. You can read more in early detection of hepatitis C.
• Hepatitis B: testing (which includes HBsAg) at least once in your life for all adults, according to the current CDC recommendations in the United States. In addition, anyone who requests the test should be able to have it, without having to disclose a reason.

In both cases this is a simple blood test. The logic is the same: you cannot treat what you do not know you have.

Who should be tested more often?

Beyond the one-time test for all adults, there are groups in whom testing should be repeated as long as exposure or risk continues:

• People who inject drugs or have done so in the past.
• People living with HIV (see hepatitis B-HIV coinfection and hepatitis C-HIV coinfection).
• People on dialysis.
• Those who received transfusions or transplants before donated blood was tested.
• Children born to a mother with hepatitis B or C.
• People who are incarcerated and those with multiple sex partners or a history of sexually transmitted infections.

The WHO 2030 elimination goal

The WHO set the goal of eliminating viral hepatitis as a public health threat by 2030, with concrete targets to reduce new infections and deaths and to diagnose and treat most infected people. The main obstacle today is underdiagnosis: most chronic hepatitis B and C infections worldwide are estimated to remain undiagnosed.

That is why vaccination (including the hepatitis B birth dose) and broad screening are the two central strategies of elimination. Without prevention, new cases keep appearing, and without diagnosis there is no treatment.

Hepatitis in Chile

Chile has committed to the WHO elimination goal. The country has a low prevalence of hepatitis B thanks to the universal vaccination built into the National Immunization Program, and hepatitis C is covered by the Explicit Health Guarantees (GES/AUGE), which ensures access to diagnosis and treatment with direct-acting antivirals both in the public system (FONASA) and in private insurers. The main challenge remains the same as in the rest of the world: to actively find the people who are already infected and do not yet know it.

What to do: ask your doctor

The message is simple and practical. If you have never been vaccinated against hepatitis A and B, or you are not sure, ask your doctor whether it applies to you. And if you are an adult and have never been tested for hepatitis B and C, request it at your next appointment. It is a simple blood test, and detecting a silent infection in time is the best way to protect your liver.

See also

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Early detection of hepatitis C