In 1883 in Bremen, 191 of 1,289 shipyard workers who were revaccinated against smallpox fell ill — and no one at the time concluded that the infection was transmitted through the needle. Today we know that the hepatitis B virus was at work. This reference explains how hepatitis B and C are transmitted, why they stay silent for years, and how they are found.
What viral hepatitis is
Hepatitis is inflammation of the liver; when a virus causes it, it is called viral hepatitis. The hepatitis B virus affects the liver and can cause an acute, short course or a chronic, multi-year one; hepatitis C also ranges from a mild illness to lifelong damage with cirrhosis. The path to understanding was long: hepatitis B was identified as a distinct disease only in 1938, in 1964 Baruch Blumberg found the "Australian antigen" in blood — the surface antigen HBsAg — and in 1970 the virions themselves, "Dane particles," were seen.
The B virus is extremely resilient: at minus 20 °C it persists for more than ten years, withstands alcohols and ultraviolet light, and its infectious potential is estimated to be 50–100 times higher than that of HIV. That is why autoclaving is not a formality.
How hepatitis B and C are transmitted
Hepatitis B passes from mother to child during childbirth, in early childhood, and also through blood and other body fluids — semen, vaginal secretions, saliva in the presence of open wounds. Sources include unsafe injections, shared needles and syringes, sharp objects, tattoos, and piercing. Hepatitis C is primarily a bloodborne infection: reused medical equipment, transfusion of untested blood, shared injection equipment. Everyday fears are misplaced here — the WHO lists what the C virus is not transmitted by:
- breast milk;
- food and water;
- hugs and kisses;
- shared food and drinks.
Why the infection stays silent for a long time
Most people have no symptoms immediately after hepatitis B infection. Some have an acute episode lasting several weeks — yellowing of the skin and eyes, dark urine, marked fatigue, nausea, vomiting, abdominal pain. Then the main issue begins: the body does not always rid itself of the pathogen. After infection in childhood, chronic hepatitis B develops in about 95% of cases; in adults, in less than 5%. Hepatitis C is similar: the acute stage is usually asymptomatic, and the chronic one gives no sign of itself for decades until liver damage begins. As of 2024, only 27% of people with hepatitis B, that is 65 million, knew their status.
Consequences: cirrhosis and liver cancer
In 2024, hepatitis B caused approximately 1.1 million deaths — mainly from cirrhosis and primary liver cancer. About a quarter of adults who acquired chronic infection in childhood later die of cancer or cirrhosis. Hepatitis C takes about 239,000 lives a year from the same causes. About 30% of infected people clear the virus on their own; in the remaining 70% the infection becomes chronic, and the risk of cirrhosis within twenty years reaches 15–30%.
Call 103 or 112 immediately for life-threatening conditions — for example, stroke or heart attack; severe acute hepatitis can lead to liver failure, so a sharp deterioration requires medical help immediately.
How it is detected and who to see
Hepatitis B cannot be distinguished clinically from hepatitis of another viral nature, so laboratory confirmation is needed. The doctor evaluates blood tests: some distinguish acute from chronic process, others show the severity of liver damage; ultrasound and elastography are added to assess fibrosis. Hepatitis C is detected in two steps — a serological antibody test, and if positive, a test for viral RNA, because antibodies persist even in those who cleared the virus on their own. The WHO recommends testing blood donors, pregnant women, people with signs of liver disease, healthcare workers, people who inject drugs, prisoners, migrants from endemic regions, and partners and relatives of infected people. In regions with a prevalence above 2%, the WHO recommends offering HBsAg testing to all adults. For routine questions, see a family doctor, who determines the scope of testing.
The B vaccine and what about hepatitis C
There is a safe and effective vaccine against hepatitis B with nearly 100% protection: it is usually given soon after birth, with booster doses a few weeks later. It was childhood vaccination that reduced the proportion of chronically infected children under five from about 5% in the pre-vaccine era to less than 1% in 2019. There is no vaccine against hepatitis C; instead, modern direct-acting antiviral therapy cures more than 95% of those infected, although access to diagnosis and treatment worldwide remains low. The decision on testing and therapy is made by a doctor.
This material is for reference: it describes the disease in general and does not replace consultation with a doctor who sees you personally.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer