Hepatitis: Social participation essential for prevention and control

As with any other disease, hepatitis cannot be controlled by relying on treatment alone. Our primary focus must therefore be on prevention. In this regard, there is no substitute for public awareness.

People need access to accurate information about which practices and habits can help them avoid hepatitis, what steps they should take if infected, when vaccination is necessary and what precautions they should follow. In particular, safe practices must be ensured in situations where infection can spread, such as blood transfusions and the use of needles. Vaccination is also an effective means of preventing hepatitis.

The media has a vital role to play in raising public awareness. It can help spread messages on hepatitis prevention from district and upazila levels to communities across the country. At the same time, members of the Hepatology Society and OGSB are well placed to reach high-risk groups directly. Their involvement will make these efforts even more effective.

The government has adopted several important plans regarding hepatitis. Preliminary discussions have already been held with the World Health Organization (WHO). Many mothers are now covered under the routine hepatitis immunisation programme. Our next goal is to prevent mother-to-child, or vertical transmission of the disease. To achieve this, initiatives are underway to effectively introduce the hepatitis birth dose within 24 hours of delivery.

The initiative is still at an early stage. Discussions are continuing at the policymaking level. At the same time, talks are also being held with Gavi, the vaccine alliance, and other development partners. We hope to take concrete steps by December. Although no final decision has yet been made, work on the initiative is progressing.

I believe that if we continue to strengthen hepatitis prevention in the same way as other Expanded Programme on Immunization (EPI) vaccines, Bangladesh will be able to reach an acceptable level of control by 2030. This will enable future generations to be in a far better position than they are today with regard to hepatitis.

Around 90 per cent of people worldwide infected with the hepatitis B or C virus do not know they are carrying the infection. This lack of awareness remains the biggest obstacle to eliminating hepatitis B and C by 2030. Overcoming this barrier would make prevention much easier.

Nearly 10 million people in Bangladesh are living with hepatitis B or C. However, the country has also made significant progress. More than 90 per cent of children are now covered by the hepatitis B vaccine under the EPI. All medicines required to treat both hepatitis B and C are manufactured domestically and are available at the lowest prices in the world. These achievements give us confidence that the 2030 target is attainable.

According to the World Health Organization (WHO), around 280 million people worldwide are currently living with chronic hepatitis B and C infections. This figure once stood at 350 million, indicating encouraging global progress. Bangladesh has also achieved notable success in this area. We are now working towards eliminating hepatitis by 2030. Nevertheless, nearly 1.1 million people still die every year from hepatitis B and C-related liver cirrhosis, liver cancer and liver failure.

When we talk about hepatitis, we are not referring only to viral infections. Fatty liver-related steatohepatitis, alcohol-related hepatitis, drug-induced hepatitis and autoimmune hepatitis are also significant conditions. I believe these forms of hepatitis will receive greater attention in global discussions in the future.

The history of World Hepatitis Day is also highly significant. In 1995, British citizen Charles Gore was diagnosed with hepatitis C. He subsequently established a trust with other patients and began raising public awareness. That initiative laid the foundation for the international hepatitis awareness movement.

Later, various patient organisations came together to form the World Hepatitis Alliance. As a result of these sustained awareness efforts, the World Health Organization officially designated 28 July as World Hepatitis Day in 2010, focusing on hepatitis B and C. The date was chosen to commemorate the birthday of Professor Baruch Samuel Blumberg, who discovered the hepatitis B virus and developed its vaccine.

In 2016, the World Health Organization set the goal of eliminating hepatitis B and C by 2030. We believe this goal is achievable because effective vaccines, curative medicines and coordinated action plans are already available.

This year's theme, ‘Hepatitis: Social Participation is essential for prevention and control’ together with the global campaign slogan,’'Let's Break It Down’, reminds us that the barriers preventing hepatitis elimination must be removed. The combined efforts of the government, healthcare professionals, the media and the public will be the greatest driving force in achieving this goal.

Although hepatitis can be caused by several viruses, hepatitis B and C are the most serious. These two viruses can lead to chronic liver disease, liver cirrhosis and liver cancer, significantly increasing the risk of premature death. Given the global target of eliminating hepatitis B by 2030, Bangladesh still has a long way to go. As a result, we are likely to continue seeing hepatitis B patients for several generations.

Hepatitis B is primarily transmitted in two ways. One is from mother to child, known as vertical transmission. The other is through contact with infected blood or bodily fluids, inadequately sterilised surgical or dental instruments, and sexual contact.

For this reason, testing for the hepatitis B surface antigen during a pregnant woman's first antenatal visit is extremely important. If the mother tests positive, her viral load should be assessed and her partner should also be tested. If the partner is not infected, they should be advised to receive the three-dose hepatitis B vaccination schedule at 0, 1 and 6 months. If the mother has a high viral load, antiviral treatment should begin after 28 weeks of pregnancy and continue for a period after childbirth.

The most important objective is to prevent transmission from mother to child. The newborn should receive the hepatitis B vaccine within 24 hours of birth—preferably within the first 12 hours—along with hepatitis B immunoglobulin. The infant should then complete the full vaccination schedule at 0, 1 and 6 months. Two months after completing the course, testing should be carried out to confirm that protective antibodies have developed.

The most important aspect of preventing hepatitis is health education. Hepatitis A and E spread through contaminated food and water, while hepatitis B and C are transmitted through blood. Many people assume that hepatitis A and E are not particularly serious. However, they too can cause liver failure. Hepatitis E, in particular, can be life-threatening for pregnant women. People must therefore be made aware of the importance of consuming safe, hygienic food and avoiding unhygienic street food.

Around 1.3 million people die from hepatitis every year. Yet most people infected with hepatitis B or C show no symptoms in the early stages. The first step in preventing the disease is screening. If hepatitis can be detected early through a blood test, patients will receive timely treatment, transmission to others will be reduced, families and communities will benefit, and serious complications such as liver cirrhosis and liver cancer will largely be prevented.

People routinely undergo tests for diabetes, cholesterol, kidney disease and heart disease. However, many never get tested to find out whether they have hepatitis.

It is particularly important to bring adults born before 2003 under hepatitis screening programmes, as they did not benefit from the hepatitis B vaccination introduced through the EPI. Our organisation has conducted screening among people from different professions and social groups in Chattogram and found that many individuals who considered themselves completely healthy were in fact carrying the hepatitis B virus.

Therefore, in addition to screening high-risk groups, all adults should be screened whenever possible. If hepatitis B and C screening can be made mandatory during the first antenatal check-up, a significant proportion of mother-to-child transmission could be prevented.

Government hospitals, including upazila health complexes, already provide these tests at low cost. Greater public awareness could help protect many people from the long-term, costly and life-threatening complications associated with hepatitis.

Every day we see many patients arriving with advanced liver disease. The worrying reality is that most of them had no idea they had been living with hepatitis B or C for years. People often seek treatment only after serious complications develop, largely because of a lack of awareness. The media is the most powerful tool for building that awareness.

The media has five particularly important responsibilities in the effort to eliminate hepatitis. First, it must ensure that accurate, science-based information reaches the public. It can play an effective role in correcting misconceptions about how hepatitis spreads, when testing is needed and when treatment should begin.

Preventive practices must also be widely promoted. Regular public health messages should encourage hepatitis B vaccination, safe blood transfusions, the use of properly sterilised medical equipment, disposable syringes and single-use blades in barber shops and salons.

The media should also encourage people to undergo screening. Since hepatitis may remain symptom-free for many years, those at risk should be tested without waiting to become ill. Early detection makes treatment easier, more effective and less costly.

Fear, stigma and social discrimination against people living with hepatitis must be eliminated. The media can also help shape public opinion in support of stronger public health policies. It has an important role in promoting wider screening, expanding vaccination coverage, improving access to modern treatment and ensuring affordable care for marginalised communities.

Not all hepatitis viruses are the same. Some cause short-term inflammation of the liver, while others lead to chronic inflammation that can eventually result in liver cirrhosis and liver cancer. Among them, the hepatitis B virus is the most significant in Bangladesh. It can infect people of all ages and is responsible for a large proportion of chronic hepatitis, liver cirrhosis and liver cancer cases.

Since Bangladesh incorporated the hepatitis B vaccine into the EPI in 2003, the prevalence of the virus has declined. The infection rate, which stood at around 9.7 per cent in 1984, fell to 5.1 per cent according to a nationwide study conducted in 2018. Even so, about 8.5 million people in the country are still living with hepatitis B. The number of infected men is higher than that of women, and the prevalence is greater in urban areas. At least one member is infected with the virus in around 1.5 million families.

At present, around 2.5 million working-age people between 15 and 30 years old are carrying the hepatitis B virus. However, many people who are only HBsAg-positive are declared unfit for employment without any scientific basis. As the Hepatology Society, we have consistently maintained that being HBsAg-positive does not mean a person is unfit for work. We must move away from this misconception. The international theme for this year's World Hepatitis Day is ‘Hepatitis: Let's Break It Down’. We must break down fear, misconceptions, social stigma and the lack of information surrounding hepatitis.

According to the World Health Organization's Global Hepatitis Report 2026, around 287 million people worldwide are currently living with chronic hepatitis B or C infections. According to data from 2024, hepatitis B and C caused 1.34 million deaths globally. The most alarming fact is that 69 per cent of these deaths occur in just 10 countries, and Bangladesh is among them.

People infected with hepatitis often remain symptom-free for many years and may unknowingly transmit the virus to other members of their families. Between 30 and 50 per cent of uninfected family members are at risk of becoming infected later. Family-based transmission is particularly common through mother-to-child transmission and sexual contact. This is why screening family members is critically important.

In regions where the prevalence of hepatitis B is two per cent or higher, every adult should undergo screening at least once in their lifetime. Vaccination is equally important. All newborns should receive the hepatitis B vaccine within 24 hours of birth, while babies born to HBsAg-positive mothers should receive the vaccine within 12 hours, preferably together with hepatitis B immunoglobulin.

At the same time, all uninfected family members of infected individuals, as well as other high-risk groups, should be brought under vaccination programmes. In certain cases, antibody testing after vaccination is also recommended, and if necessary, repeat vaccination or a booster dose should be administered.

The World Health Organization's goal of eliminating viral hepatitis by 2030 cannot be achieved by any single institution. It requires the combined efforts of the government, the medical community, the media, development partners and the public. Within this collective effort, the Hepatology Society, Dhaka, Bangladesh serves as an important scientific and professional platform. We believe that awareness is the first antidote to ignorance, and knowledge is the first step towards elimination.

Every year, to mark World Hepatitis Day, we organise a range of awareness activities, including rallies, seminars, roundtable discussions, television talk shows, newspaper articles and social media campaigns. Our message is simple and clear: hepatitis is preventable, treatable and, in many cases, curable.

Alongside public awareness, we place equal importance on improving the skills of healthcare professionals. Research is also one of our key priorities. Studies on the true burden of viral hepatitis, treatment outcomes and prevention strategies play an important role in shaping national policies and future action plans. At the same time, we work closely with the Ministry of Health and Family Welfare, the Directorate General of Health Services, medical universities and international organisations to develop national guidelines, provide training and offer public health advice.