Hepatitis B and C: Testing, Vaccination and Why Cure Is Now Possible
Viral hepatitis B and C together account for a large share of cirrhosis and liver cancer worldwide, and India carries a substantial part of that burden. Both are usually silent for decades. The encouraging part is that hepatitis B is preventable with a vaccine and controllable with treatment, and hepatitis C is now curable in the large majority of people with a short course of tablets.
Hepatitis B
Transmission. Blood and body fluids. The dominant routes in high-prevalence settings are mother to child at birth and early childhood household transmission. Other routes include unsafe injections and medical procedures, unscreened blood transfusion, shared razors and toothbrushes, unsterile tattooing, piercing and dental work, injecting drug use and sexual contact. It is not spread by sharing food, water, utensils, hugging, coughing or mosquito bites.
Course. Infection acquired in infancy becomes chronic in about 90 percent of cases; acquired in adulthood, in under 5 percent. This is why birth-dose vaccination matters so much.
Symptoms. Acute infection may cause fatigue, nausea, right upper abdominal discomfort, dark urine, pale stools and jaundice, but is often silent. Chronic infection is typically asymptomatic until cirrhosis or cancer develops.
Testing. HBsAg, the surface antigen, indicates current infection. Anti-HBs indicates immunity, from vaccination or past cleared infection. Anti-HBc total indicates past exposure. If HBsAg is positive, further tests determine the phase: HBeAg, anti-HBe, HBV DNA viral load, liver enzymes and fibrosis assessment, plus screening for hepatitis D, C and HIV.
Treatment. Not everyone with chronic hepatitis B needs treatment, which is a point of frequent confusion. Treatment is indicated based on viral load, liver enzyme levels and fibrosis stage. When indicated, tenofovir or entecavir suppress the virus very effectively and reduce the risk of cirrhosis and cancer. Treatment is usually long term rather than curative, and stopping without medical supervision can cause a dangerous flare.
Monitoring. Those not on treatment still need periodic review, typically every six to twelve months, and people with cirrhosis or other risk factors need six-monthly ultrasound and alpha-fetoprotein surveillance for liver cancer.
Vaccination. Safe, effective and part of the national immunisation schedule, with a birth dose followed by further doses. Adults at risk should be vaccinated: healthcare workers, dialysis patients, people with chronic liver disease, household and sexual contacts of infected people, people with diabetes, and anyone requesting it. A post-vaccination anti-HBs test confirms response in high-risk groups.
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Pregnancy. All pregnant women should be tested. Infants of positive mothers receive hepatitis B immunoglobulin plus vaccine within hours of birth, and antiviral treatment in late pregnancy for mothers with high viral load dramatically reduces transmission.
Hepatitis C
Transmission. Primarily blood-to-blood. Unsafe injections and reused needles, unscreened transfusions before routine testing, injecting drug use, unsterile medical, dental and cosmetic procedures. Sexual and mother-to-child transmission occur but are less efficient than with hepatitis B.
Course. About 15 to 45 percent clear the virus spontaneously. The remainder develop chronic infection, with cirrhosis in a substantial minority over 20 to 30 years, and risk of liver cancer thereafter.
Symptoms. Usually none for years. Fatigue is the commonest complaint. Some people have extrahepatic features including a particular pattern of kidney disease, skin rash, joint pain and an association with insulin resistance.
Testing. Anti-HCV antibody is the screening test. A positive antibody means exposure, not necessarily current infection, so it must be followed by HCV RNA to confirm active infection. Genotype testing is less necessary with modern pangenotypic drugs. Fibrosis is assessed by elastography or non-invasive scores.
Treatment. Direct-acting antivirals, typically taken for 8 to 12 weeks, cure more than 95 percent of patients with few side effects. Generic versions have made this affordable in India, a genuine public health success. Cure is confirmed by an undetectable HCV RNA 12 weeks after finishing treatment.
Importantly, cure removes the virus but does not reverse established cirrhosis, so those with advanced fibrosis continue liver cancer surveillance afterwards. Reinfection is possible if exposure continues.
No vaccine exists for hepatitis C, which makes prevention of exposure the only primary protection.
Who should be tested
- Anyone who received a blood transfusion or blood product, particularly before routine screening
- Anyone who has had unsafe injections, dialysis, or surgery or dental work in unregulated settings
- People who inject drugs, past or present
- Healthcare workers with needle-stick exposure
- Household and sexual contacts of infected people
- Children of infected mothers
- People with unexplained raised liver enzymes
- People with HIV
- Anyone with tattoos or piercings from unregulated premises
- In practice, a one-time test for both is reasonable for most adults
Living with either infection
Avoid alcohol, which accelerates fibrosis markedly. Be vaccinated against hepatitis A and, for hepatitis C patients, hepatitis B. Avoid unverified herbal liver tonics, which are a common cause of additional liver injury. Maintain a healthy weight, since fatty liver compounds the damage. Do not share razors, toothbrushes or nail clippers. Tell healthcare and dental providers. Discuss any new medication, including over-the-counter painkillers, with your doctor.
There is no reason to exclude anyone with viral hepatitis from work, school, shared housing, shared meals or ordinary social contact. The stigma does more harm than the virus in many families.
This is general information. Whether and when to treat chronic hepatitis B, and which regimen suits hepatitis C, are specialist decisions.