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Hepatitis 

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Hepatitis 

Hepatitis refers to inflammation of the liver, most commonly caused by hepatotropic viruses, but it can also result from toxins, drugs, alcohol, autoimmune responses, and metabolic disorders. Viral hepatitis comprises five primary types—Hepatitis A, B, C, D, and E—each caused by a different virus with distinct characteristics and implications for human health 1. 

Characteristics and Habitat 

Hepatitis viruses are diverse in structure and replication. Hepatitis A (HAV) and hepatitis E (HEV) are non-enveloped RNA viruses found in the gastrointestinal tract and transmitted via the faecal–oral route. Hepatitis B (HBV) is a partially double-stranded DNA virus, while Hepatitis C (HCV) and Hepatitis D (HDV) are RNA viruses transmitted through blood and bodily fluids. HBV and HCV primarily inhabit hepatocytes and have a higher propensity for chronic infection 1,3. 

Role in Human Health 

Hepatitis significantly impacts liver function and overall health. Acute infections may cause jaundice, fatigue, abdominal pain, and elevated liver enzymes. Chronic infections, particularly from HBV and HCV, may lead to fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma 1,4. In 2024, the World Health Organization (WHO) estimated that hepatitis B and C alone are responsible for over 1.1 million deaths annually 1. 

Epidemiological Data – Australia, New Zealand, Pacific 

Australia: In 2023 an estimated 219,800 people were living with chronic hepatitis B (CHB), representing 0.82% of the population 13 and estimated 74 400 people remained living with chronic hepatitis C at the end of 2022 14. Despite treatment availability, over 95% remain undiagnosed or untreated 7. Current treatment numbers are estimated at 100 684 people living with chronic hepatitis C initiated DAA therapy (first treatment) 14. 

New Zealand: 100,000 people have had HBV infection, with higher prevalence among Māori, Pasifika, and Asian groups; 25,000 are estimated to have HCV 8. 

Pacific Islands: Some countries, such as Papua New Guinea and Kiribati, report HBV prevalence above 8%, placing them in the high endemicity category 9. 

Transmission 

HAV and HEV are excreted in faeces and are transmitted via ingestion of faecally contaminated food or water, often in regions with poor sanitation. HBV, HCV, and HDV are spread through blood-to-blood exposure, that means the blood of someone with HBV, HCV or HDV must enter someone’s blood stream. The most common way that HBV is spread around the world is mother-to-child transmission and sexual contact. HCV is commonly spread through sharing of injecting equipment. HDV occurs only in individuals with HBV infection due to its dependence on HBV for replication 1,4. 

Diagnosis 

Diagnosis is based on serological and molecular tests. Antigen and antibody assays (e.g., HBsAg, anti-HCV) are used for screening, while PCR detects viral RNA or DNA to confirm active infection and determine viral load. Liver function tests and imaging assess the extent of liver damage 3,4. 

Treatment 

Treatment varies by virus type. HAV and HEV are self-limiting and do not require antiviral therapy 1. HBV is managed with nucleos(t)ide analogues, e.g., tenofovir or entecavir, which suppress viral replication 3,4. HCV is curable with direct-acting antivirals (DAAs) such as sofosbuvir-velpatasvir or Glecaprevir-Pibrentasvir 4. HDV treatment is limited but includes interferon-based therapies and emerging antiviral agents 4. 

Prevention 

Prevention strategies include vaccination (available for HAV and HBV and as a result of HBV vaccination people are protected against HDV), safe injection practices, blood screening, safe sex, and improved sanitation 1,6. Australia’s National Immunisation Program includes HBV vaccination for infants 6. Harm reduction programs, such as needle and syringe exchange services, are also critical to curbing HCV transmission 2,11,12. 

The global goal is to eliminate hepatitis by 2030 1,2. 

References  

  1. World Health Organization. (2024). Hepatitis. https://www.who.int/news-room/fact-sheets/detail/hepatitis 
  2. Australian Government Department of Health and Aged Care. (2023). Fourth National Hepatitis B Strategy 2023–2030. https://www.health.gov.au/sites/default/files/2023-05/draft-fourth-national-hepatitis-b-strategy-2023-2030-for-public-consultation.pdf 
  3. ASHM. (2024). Hepatitis B: Decision-Making Tool for General Practice. https://ashm.org.au/resources/decision-making-in-hepatitis-b/ 
  4. ASHM. (2024). Management and care of hepatitis B and C. https://ashm.org.au/hepatitis-b-toolkit/management-and-care-of-hepatitis-b/ 
  5. ASHM. (2022). B Positive: Hepatitis B Guide for Primary Care (4th ed.). https://ashm.org.au/resources/hepatitis-b-guide-for-primary-care-fourth-edition/ 
  6. Australian Government Department of Health and Aged Care. (2024). National Immunisation Program. https://www.health.gov.au/topics/immunisation/immunisation-throughout-life/national-immunisation-program 
  7. Kirby Institute. (2023). HIV, Viral Hepatitis and STIs in Australia: Annual Surveillance Report 2023. https://www.kirby.unsw.edu.au/research/reports/asr2023 
  8. The Hepatitis Foundation of New Zealand. (2023). About hepatitis in New Zealand. https://www.hepatitisfoundation.org.nz/ 
  9. WHO Western Pacific Region. (2023). Regional Overview: Hepatitis in the Pacific. https://www.who.int/westernpacific/health-topics/hepatitis Australian Government Department of Health and Aged Care. (2023).
  10. Draft National Hepatitis B Strategy 2023–2030. https://www.health.gov.au/sites/default/files/2023-05/draft-fourth-national-hepatitis-b-strategy-2023-2030-for-public-consultation.pdf 
  11. Australian Government Department of Health and Aged Care. (2023). Draft National Hepatitis C Strategy 2023–2030. https://www.health.gov.au/resources/publications/draft-sixth-national-hepatitis-c-strategy-2023-2030-for-public-consultation 
  12. Hepatitis Australia. (2024). National Hepatitis Response and Community Resources. https://www.hepatitisaustralia.com/ 
  13. WHO Collaborating Centre for Viral Hepatitis. (2023). National surveillance for hepatitis B indicators: Annual report 2023 (Final report). The Peter Doherty Institute for Infection and Immunity. https://www.doherty.edu.au/uploads/content_doc/National_Surveillance_for_Hepatitis_B_Indicators_2023_Final_with_cover.pdf 
  14. Burnet Institute & Kirby Institute. (2023). Australia’s progress towards hepatitis C elimination: Annual report 2023 (Report No. ISBN 9780646889030; DOI 10.26190/4d4f5n41). Burnet Institute. https://www.burnet.edu.au/media/tahd41iz/australias-progress-towards-hepatitis-c-elimination-annual-report-2023.pdf