Silent epidemic: why South Africans are unknowingly carrying hepatitis

Thousands of South Africans are carrying a liver infection they know nothing about. Viral hepatitis kills roughly 1.3 million people globally each year, a toll that matches tuberculosis, yet in South Africa the disease remains largely invisible.

The core problem is hepatitis’s deceptive nature. Hepatitis B and hepatitis C, the two forms responsible for the vast majority of serious illness and death, can persist for years without producing any noticeable symptoms. A person infected with either virus may feel entirely well while it quietly damages their liver. When symptoms finally emerge, they often include fatigue, fever, nausea, vomiting, loss of appetite, dark urine, pale stools, yellowing of the skin and eyes, and abdominal pain. By that point, liver damage may already be severe. This is why hepatitis is frequently called a “silent disease.”

Hepatitis refers to inflammation of the liver. Alcohol use, certain medications, and autoimmune diseases can all cause it, but viral hepatitis remains the most common cause worldwide. Five main hepatitis viruses exist: A, B, C, D, and E. Hepatitis B and C stand apart because they can become chronic infections, leading to severe liver disease, liver cancer, and premature death.

South Africa carries a particular burden with hepatitis B. The country introduced hepatitis B vaccination into its childhood immunisation programme in 1995, a step that dramatically reduced infections among younger generations. Many adults born before the vaccine became routinely available, however, remain at greater risk. Public health experts estimate that hundreds of thousands of South Africans are living with chronic hepatitis B, yet many have never been tested or diagnosed. Hepatitis C, while less common in the general population, remains a concern among people with specific risk factors. The encouraging reality is that hepatitis C is now curable with modern antiviral medicines when caught early.

The transmission routes differ by virus type. Hepatitis A and E spread through contaminated food or water and typically cause short-term illness. Hepatitis B spreads through contact with infected blood and bodily fluids, through unprotected sex, shared needles or syringes, mother-to-child transmission during childbirth, and unsafe medical or cosmetic procedures using unsterilised equipment. Hepatitis C spreads primarily through blood-to-blood contact, including shared injecting equipment and, less commonly, unsafe healthcare procedures. None of these viruses spread through casual contact such as hugging, sharing food, coughing, or sneezing.

Meanwhile, healthcare providers recommend testing for several groups: people born before routine hepatitis B vaccination was introduced, those with a family member living with hepatitis B, people who have had multiple sexual partners, those who inject drugs or have previously shared needles, individuals who received blood transfusions or certain medical procedures before improved screening practices were introduced, people living with HIV, and workers in healthcare settings with potential exposure to blood. Pregnant women are also routinely screened for hepatitis B in many healthcare settings to reduce the risk of passing the virus to their babies.

Prevention and treatment options exist. Vaccines are available for hepatitis A and hepatitis B, with the hepatitis B vaccine included in South Africa’s Expanded Programme on Immunisation. No vaccine currently exists for hepatitis C, but highly effective direct-acting antiviral medicines can cure more than 95 percent of infections when treatment begins early. For people living with chronic hepatitis B, antiviral treatment can suppress the virus, reduce liver damage, and lower the risk of liver cancer. Simple blood tests can diagnose hepatitis, allowing patients to receive monitoring or treatment before complications develop.

Every July 28, World Hepatitis Day draws attention to one of the world’s deadliest infectious diseases. The real question is whether South Africans at risk will get the chance to know their status before the damage is already done.