More than 350 million people worldwide are living with hepatitis B or C - and most don’t know it. These viruses don’t always cause symptoms until the liver is badly damaged. But the good news? We now have tools to stop them in their tracks. The real challenge isn’t science - it’s access, awareness, and action.
How Hepatitis B and C Spread - And What Doesn’t Spread Them
Hepatitis B and C are blood-borne viruses, but they don’t spread the same way. Hepatitis B is far more contagious. It can live outside the body for up to seven days. You can catch it from a used needle, unprotected sex, or even sharing a toothbrush if there’s blood on it. In places like sub-Saharan Africa or parts of Asia, most infections happen when babies are born to infected mothers. About 40 to 90% of chronic hepatitis B cases in high-risk areas come from mother-to-child transmission during birth. Sexual contact is another major route. Unvaccinated partners of someone with hepatitis B have a 30 to 60% chance of catching it. Men who have sex with men, people with multiple partners, and those with other sexually transmitted infections are at higher risk. Healthcare workers face exposure too - a needlestick injury can lead to infection in 6 to 30% of cases, depending on the viral load. Hepatitis C spreads almost entirely through blood. The biggest driver today? The opioid crisis. In the U.S., cases jumped 71% between 2014 and 2018, mostly among people aged 20 to 39 who inject drugs. Sharing needles, syringes, or even cookers and cotton filters can spread the virus. It can also be passed from mother to child during pregnancy - about 5 to 6% of the time. But here’s what you don’t need to worry about: hugging, kissing, sharing food, using the same toilet, or being coughed on. Hepatitis B and C aren’t airborne. You can’t catch them from a handshake or a public pool. Fear and stigma still keep people from getting tested - but the virus doesn’t spread like the flu.Who Should Get Tested - And When
Testing is the first step to stopping these viruses. The CDC now recommends everyone get tested for hepatitis C at least once in their life, starting at age 18. Pregnant people should be tested during every pregnancy. For hepatitis B, the same applies: one-time screening for all adults, with extra testing for high-risk groups. High-risk groups include:- People who inject drugs - even once, years ago
- People living with HIV - up to 90% of those who inject drugs and have HIV also have hepatitis C
- Healthcare workers after a needlestick injury
- People born between 1945 and 1965 - they’re five times more likely to have hepatitis C
- People who got tattoos or piercings in unregulated settings
- People born in countries with high hepatitis B rates - like parts of Africa, Asia, the Pacific Islands, or Eastern Europe
- People in prisons or detention centers - prevalence here is 6 to 15%
- People with abnormal liver enzyme tests
Testing Has Changed - Fast, Simple, and Accessible
Gone are the days of waiting days for results. Point-of-care tests now give answers in minutes. The OraQuick HCV Rapid Antibody Test, approved by the FDA in 2010, gives results in 20 minutes using a finger-prick sample. New hepatitis B rapid tests have shown 98.5% sensitivity and 99.5% specificity in field studies - meaning they’re almost perfect at catching true cases and ruling out false ones. These tests are being used in mobile clinics, pharmacies, and community centers - especially in places where people don’t have easy access to hospitals. In Egypt, community health workers went door-to-door with these tests and cut hepatitis C prevalence from 14.7% in 2008 to 0.9% in 2021. That’s not magic - it’s scale. In South Africa, where I’m based, mobile testing units now visit informal settlements and rural clinics. We’re seeing more people come forward once testing becomes simple and free. No more waiting weeks. No more stigma. Just a quick prick and an answer.
Hepatitis C: A Cure That Actually Works
Before 2011, hepatitis C treatment meant weekly injections of interferon, side effects like depression and fatigue, and only a 50% cure rate. Today? A 12-week course of pills cures over 95% of people. The drugs are called direct-acting antivirals (DAAs). Brands like Epclusa (sofosbuvir/velpatasvir) and Mavyret (glecaprevir/pibrentasvir) work against all six genotypes of hepatitis C. They’re taken once a day. Side effects? Usually none. No needles. No hospital visits. Just pills. The cost used to be $84,000 per course in the U.S. in 2014. Now, thanks to generics and negotiations, it’s under $300 in low-income countries. In South Africa, the government provides DAAs for free through public clinics. The problem isn’t the drug - it’s getting people tested and linked to care. Only 21% of people with hepatitis C were treated in 2020, even though the cure exists.Hepatitis B: No Cure Yet - But Better Control
Unlike hepatitis C, hepatitis B can’t be cured yet. But we can control it. Nucleos(t)ide analogues like tenofovir alafenamide (TAF) and entecavir suppress the virus so well that most people never develop cirrhosis or liver cancer. TAF is now preferred over older drugs like tenofovir disoproxil - it’s easier on the kidneys and bones. Treatment usually lasts lifelong. Stopping too early can cause a dangerous flare-up. Annual costs in the U.S. range from $6,000 to $12,000, but generics are available in many countries for under $50 a year. The only chance at a functional cure - where HBsAg disappears and the immune system takes over - comes from pegylated interferon. But only 3 to 7% of people achieve this after 48 weeks of treatment. It’s harsh, with flu-like symptoms and mood changes. Most doctors reserve it for younger patients with high immune activity. New drugs are in trials. siRNA therapies like JNJ-3989 and capsid modulators are showing promise in phase 3 studies. They could one day let people stop treatment safely. But they’re not here yet. For now, lifelong suppression is the goal.The Vaccine That Works - But Isn’t Used Enough
The hepatitis B vaccine is one of the greatest public health successes of the last 50 years. It’s been available since 1986. It’s safe, effective, and lasts at least 20 years - likely for life. The key? Giving the first dose within 24 hours of birth. In high-risk areas, this cuts mother-to-child transmission by 90%. Yet in the U.S., only 66.5% of adults received the full three-dose series in 2021. The target is 90%. Why the gap? Lack of awareness. Vaccine hesitancy. Poor access. In countries like Rwanda and Thailand, birth-dose coverage is over 90%. In South Africa, it’s around 75%. We’re getting there - but not fast enough. Every baby born to a hepatitis B-positive mother who doesn’t get the vaccine and hepatitis B immune globulin (HBIG) within 12 hours has a 90% chance of becoming chronically infected.
What’s Still Holding Us Back
We have the tools. We have the science. So why are hepatitis-related deaths still rising? First, stigma. People still think hepatitis is punishment for drug use or promiscuity. That keeps them from getting tested. Second, cost. Even with generics, some places still charge for testing. Insurance won’t cover it. Clinics don’t have the staff. Third, fragmentation. Hepatitis B and C services are often separate from HIV, mental health, or addiction care. But most people with hepatitis C also have substance use issues. Most with hepatitis B also have HIV. We need integrated care - not silos. The WHO wants to reduce new infections by 90% and deaths by 65% by 2030. We’re not on track. Without scaling up testing, vaccination, and treatment - especially in low-income countries - we could see 1.1 million deaths from viral hepatitis by 2025.What You Can Do Right Now
If you’re over 18: get tested for hepatitis C. One blood test. No symptoms needed. If you’re pregnant: ask for hepatitis B and C screening. It’s part of routine prenatal care - but not everyone asks. If you’ve ever used drugs, even once: get tested. Don’t wait for symptoms. If you’re a parent: make sure your baby gets the first hepatitis B shot in the delivery room. It’s that simple. If you’re a healthcare worker: follow safety protocols. Use sharps containers. Never recap needles. If you’re in a high-risk group - MSM, incarcerated, born in an endemic country - get tested now. Don’t wait for a crisis. We can end these epidemics. Not in 20 years. Not in 10. But now - if we act.Can you get hepatitis B from kissing or sharing food?
No. Hepatitis B is not spread through casual contact like kissing, hugging, sharing meals, or using the same toilet. The virus is in blood and certain body fluids - not saliva, sweat, or tears. You can’t catch it from a handshake or coughing. The only risk from kissing would be if there’s open bleeding in the mouth - which is extremely rare.
Is hepatitis C curable?
Yes. Modern direct-acting antivirals (DAAs) cure more than 95% of people with hepatitis C in just 8 to 12 weeks. These are oral pills with few side effects. Once cured, the virus is gone from your blood, and liver damage can begin to heal. You can’t get reinfected from the same strain, but you can catch it again if exposed to infected blood.
Can you get hepatitis B even if you’re vaccinated?
It’s extremely unlikely. The hepatitis B vaccine is 95% effective at preventing infection when the full series is completed. Protection lasts at least 20 years and probably for life. If you were vaccinated as a child and are unsure, a simple blood test (anti-HBs) can check your immunity. Booster doses aren’t needed for most people.
How do I know if I have chronic hepatitis B or C?
Chronic means the infection lasted longer than six months. For hepatitis B, if HBsAg is still positive after six months, it’s chronic. For hepatitis C, if HCV RNA is still detectable after six months, it’s chronic. Most people don’t feel sick - that’s why testing is critical. Blood tests are the only way to know for sure.
Can hepatitis B turn into hepatitis C?
No. Hepatitis B and C are caused by completely different viruses. One cannot turn into the other. But someone can be infected with both at the same time - especially if they’ve had multiple exposures, like through injection drug use or unprotected sex. Co-infection makes liver damage more likely, so testing for both is important.
Are there side effects from hepatitis B or C treatment?
Hepatitis C treatment with DAAs has almost no side effects - maybe mild fatigue or headache. Hepatitis B antivirals like tenofovir are also well-tolerated, but long-term use can affect kidney or bone health in rare cases. Pegylated interferon for hepatitis B causes flu-like symptoms, depression, and fatigue - so it’s rarely used now. Always discuss risks with your doctor.
Can I still work or have children if I have hepatitis B or C?
Yes. People with hepatitis B or C can work, have relationships, and have children. With hepatitis B, babies can be protected at birth with the vaccine and HBIG. With hepatitis C, pregnancy is safe - the risk of passing it to the baby is low (5-6%). Treatment during pregnancy isn’t recommended, but you can be cured after delivery. No one needs to know your status unless you choose to tell them.
Next Steps: What to Do If You’re Diagnosed
If you test positive for hepatitis B or C, don’t panic. The next steps are simple:- See a liver specialist or infectious disease doctor - even if you feel fine.
- Get a liver ultrasound and FibroScan to check for scarring.
- For hepatitis B: start antivirals if your doctor recommends it. Get vaccinated against hepatitis A if you haven’t.
- For hepatitis C: start treatment right away. It’s short, simple, and life-saving.
- Tell your sexual partners and household members - so they can get tested.
- Avoid alcohol and unnecessary medications that stress the liver.