Testing and vaccination are central to preventing, detecting, and treating viral hepatitis.

This is the message from the National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), as South Africa observes World Hepatitis Day today.

Hepatitis is inflammation of the liver often caused by a virus.

Viral hepatitis is a significant health concern worldwide. There are five main hepatitis viruses: A, B, C, D and E. These five types are of significant concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people worldwide and, together, are the most common cause of liver cirrhosis and cancer.

Time for action

World Hepatitis Day, observed under the theme ‘Time for action’, is a call for proactiveness and action on viral hepatitis.

The NICD’s Centre for Vaccines and Immunology (CVI) performs passive laboratory-based surveillance for hepatitis A, B and C using data from the NHLS corporate data warehouse comprising laboratory data from the public health sector.

Between April 1, 2023, and March 31, 2 570 hepatitis A cases were confirmed with a positive hepatitis A IgM antibody test throughout NHLS laboratories nationally.

“A significant increase in hepatitis A cases was seen in Western Cape in the City of Cape Town, Cape Winelands, West Coast and Garden Route districts. Sub-genotype IB was detected in the Western Cape region.

“Four other metros also reported an increased number of hepatitis A cases: the City of Johannesburg (198 cases), the City of Tshwane (339), and Ekurhuleni and eThekwini reported 189 cases. Both KZN and Gauteng were alerted for a public health response,” says the head of the CVI, Dr Nishi Prabdial-Sing.

The risks of hepatitis A and E are associated with a lack of clean water, poor sanitation and hygiene. Damage to the sewerage infrastructure by factors such as floods may contribute to increased hepatitis A and E infections. Personal practices such as regular handwashing before and after using the bathroom can prevent hepatitis A and E.

Between April 1, 2023, and March 31, national NHLS laboratories tested 140 243 cases for hepatitis B surface antigen, of which 40 394 (3.5%) tested positive. Of these, the majority – 28 945 (71.66%) – were 25 to 49 years old, and 115 cases (0.3%) were in children under one.

Although South Africa has shown great success in decreasing hepatitis B surface antigen prevalence from high to intermediate levels with the incorporation of the hepatitis B vaccine in the EPI since 1995, there are still children and young adults who test positive for the virus.

More must be done to increase the complete dosage of vaccines and vaccine coverage for vaccine-preventable diseases.

“The number of people with active hepatitis C infection has increased due to the inclusion of data from programmes of people at high risk. The gaps in affordable and accessible tests and treatment must be addressed to achieve the goal of eliminating viral hepatitis by 2030,” says Prabdial-Sing.

Between April 1, 2023, and March 31, 213 309 patients were tested for hepatitis C virus exposure with a hepatitis C antibody test. Of the 7 583 (3.6%) positive results, only 971 (12.8%) patients had a hepatitis C viral load test, of which 69.1% (671) were positive. Increasing the testing for hepatitis C viral load will assist in placing more people on treatment and prevent new hepatitis C infections.

The common modes of transmission for hepatitis B and C include exposure to infected blood or blood products, invasive medical procedures using contaminated equipment, unsafe intravenous drug use and hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact. You can protect yourself against hepatitis B by being vaccinated.

Watch: Surviving Hepatitis, Koketso Makubane’s story:

Watch: Understanding Hepatitis with Michelle Marais: