Hepatitis infection is an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading to a range of health problems, some of which can be fatal. There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While they all cause liver disease, they differ in important ways including modes of transmission, severity of the illness, geographical distribution and prevention methods. According to the World Health Organization (WHO), in particular, types B and C lead to chronic disease in hundreds of millions of people, especially in Africa, and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths. An estimated 354 million people worldwide live with hepatitis B or C, and for most, testing and treatment remain beyond reach. Doctors Without Borders (MSF) strives to provide access to these measures across the world.
Hepatitis A is a liver infection caused by the hepatitis A virus (HAV), transmitted through contaminated food, water, or direct contact with an infected person. While most people recover fully and gain lifelong immunity, severe cases can lead to fulminant hepatitis, which can be fatal. The risk is higher in areas with poor sanitation and hygiene. Fortunately, a safe and effective vaccine is available for prevention.
Hepatitis B is a viral infection that attacks the liver, causing acute or chronic disease. It spreads from mother to child at birth, in early childhood, and through contact with infected blood or body fluids. In 2022, an estimated 254 million people lived with chronic hepatitis B, with 1.2 million new infections and 1.1 million deaths, mainly from cirrhosis and liver cancer. A safe and effective vaccine is available for prevention.
Hepatitis C is a liver infection caused by the hepatitis C virus, which can lead to both acute and chronic disease, including cirrhosis and liver cancer. It spreads primarily through blood exposure from unsafe injections, unscreened transfusions, and injection drug use. An estimated 50 million people live with chronic hepatitis C, with 1 million new infections and 242,000 deaths in 2022. While direct-acting antivirals can cure over 95% of cases, access to treatment remains low, and no effective vaccine is available.
Hepatitis D is a virus that depends on hepatitis B for replication, affecting about 5% of people with chronic hepatitis B. It spreads through co-infection (simultaneous infection with HBV and HDV) or super-infection (HDV after HBV). High-risk groups include indigenous populations, haemodialysis patients, and people who inject drugs. Although global HDV infections have declined due to widespread hepatitis B vaccination, HBV-HDV co-infection is the most severe form of viral hepatitis, leading to faster liver damage. Hepatitis D can be prevented through hepatitis B immunisation, but treatment success remains low.
Hepatitis E is a liver infection caused by the hepatitis E virus (HEV), primarily transmitted through contaminated water. It leads to an estimated 3.3 million symptomatic cases annually, with 44,000 deaths recorded in 2015. While found worldwide, it is most common in East and South Asia. A vaccine exists but is currently only licensed in China.
Chronic viral hepatitis is a major problem worldwide. Rapid access to diagnostics and treatment are urgently needed. MSF’s treatment of hepatitis is aimed at groups that are often harder to treat; often, the people we care for are from marginalised groups, such as those living with HIV and tuberculosis (TB), prisoners, people who use drugs and sex workers. We aim to provide comprehensive care where treatment for HIV and TB is also available, as these infections are more common in people with hepatitis B and C.
In many of the places MSF works, the testing and treatment of hepatitis are often overlooked and underfunded, as the effects of the virus are not immediately seen. But it is clear that the burden of the disease is great and that poor treatment has long term consequences for individuals and communities. To raise awareness, we train host country staff and work to bring hepatitis care into local services.
Short-term hepatitis A, B, and E infections do not often require treatment, but patients can be given supportive care like administering fluids if needed.
Chronic hepatitis C infection was previously treated with pegylated interferon, an expensive and burdensome treatment. It can cause severe side-effects like depression, which often leads to people stopping treatment early. However, new oral treatments called ‘directly-acting antiviral agents’ have been developed. These are more effective at combating the infection and do not produce as many side effects.
MSF is using a simplified approach based on pangenetic regimens – treating all strains of the hepatitis virus – with oral antivirals for 12-24 weeks. The outcomes from these treatments are impressive and can lead to a complete cure. However, access to this treatment, especially in resource-limited settings, is an ongoing issue. MSF's Access Campaign is campaigning to reduce the cost of medications and improve access to all.
Prevention of hepatitis A and E, where the virus is transmitted through food or water contaminated by an infected person’s faeces, relies on access to clean water and functioning sewage disposal systems. MSF provides water and sanitation specialists in places like refugee and displacement camps.
Preventing hepatitis C, where the virus is transmitted by contact with an infected person’s blood, often through the use of unsterilised needles, relies on reducing the risk of exposure by promoting safe handling and cleaning of needles, as well as improving access to clean blood for transfusions.
Vaccination is the most effective method to prevent hepatitis B infection, as it is transmitted from mother to child during pregnancy and deliver and by contact with an infected person’s blood or other body fluids. The vaccine is widely available and very safe. MSF has vaccinated against the virus in countries like Central African Republic, Afghanistan, Syria, Pakistan and Nigeria. We focus on newborns, young children and other vulnerable groups. While a vaccine exists for hepatitis E, it is currently only licensed to be manufactured in China, making it very difficult to source and transport the vaccine to affected rural areas.
Our financial independence enables us to freely evaluate medical needs, reach communities in need without restriction, and directly provide high-quality medical care to help prevent and treat hepatitis around the world.
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