As we observe World Hepatitis Day, it is crucial to shed light on the silent epidemic that affects millions of lives worldwide. Viral hepatitis has been a long-neglected public health challenge. The impact of this disease on individuals, families, and communities demands urgent attention and collaborative efforts to eliminate its burden.

Viral hepatitis is inflammation of the liver resulting mostly from infections caused by hepatitis viruses, known as hepatitis A, B, C, D, and E. Among these, hepatitis B and C have garnered significant attention due to their ability to establish chronic infections in a considerable proportion of those infected, leading to severe liver complications such as cirrhosis, liver failure, and even liver cancer.

The modes of transmission for these viruses vary, with hepatitis A predominantly spread through contaminated food and water, while hepatitis B and C are transmitted through sexual contact, blood or blood products, and from mother to child during pregnancy or breastfeeding. Sadly, people who inject drugs are at higher risk of contracting hepatitis B and C, underscoring the need for targeted interventions in this vulnerable population.

Globally, there are 325 million people chronically infected with hepatitis B and C viruses, leading to about 1 million deaths annually. South Africa, like many other countries, faces its share of challenges in combating viral hepatitis. The burden of hepatitis B virus infections in our nation is considerable, with approximately 3.4 million people living with the virus. Although we have made strides in reducing the prevalence of hepatitis B, particularly through the implementation of vaccination programmes, there is still much work to be done, especially in rural areas where the prevalence remains higher.

On the other hand, hepatitis C virus prevalence is relatively low in the general population, estimated at 1-2%. However, its prevalence is higher among those who inject drugs, highlighting the importance of harm reduction strategies and targeted testing and treatment programmes.

Fortunately, significant progress has been made in diagnosing and treating hepatitis viruses. Enzyme immunoassays (EIAs) are widely available in centralised laboratories for diagnosis, but rapid tests are now accessible at point-of-care facilities, facilitating faster diagnosis and linkage to care. Moreover, the availability of directly acting antiviral (DAA) drugs has revolutionised the treatment landscape for hepatitis C, providing cure rates of 95% or higher and significantly shortening treatment duration.

To achieve elimination targets set by the World Health Organization (WHO) for 2030, we must focus on prevention and access to treatment. Vaccination against hepatitis A and B remains one of the most effective preventive measures, and strengthening our vaccination programmes, especially in underserved communities, can contribute significantly to reducing new infections. Furthermore, we must prioritise making diagnostics and treatments more affordable and accessible to all, especially in low-income communities, where the burden of viral hepatitis is often the highest.

Universal health initiatives play a pivotal role in ensuring equitable access to services required for the management and prevention of viral hepatitis. Global and national efforts have set the stage for progress, but we must now translate these efforts into action at the ground level. As a nation, we have the opportunity to fast-track the development of hepatitis management guidelines and implement comprehensive programmes that focus on prevention, testing, and treatment.

The COVID-19 pandemic undoubtedly posed significant challenges to healthcare systems worldwide, and South Africa was no exception. However, as we emerge from the pandemic's shadow, we must seize the opportunity to revive and strengthen our efforts to combat viral hepatitis. Let us not allow this silent epidemic to persist in the shadows any longer.

As a leading academic institution, the University of Pretoria stands at the forefront of medical research and education. Our commitment to addressing public health challenges, including viral hepatitis, remains unwavering. Together with government agencies, non-governmental organisations, and international partners, we can unite against viral hepatitis and work towards its elimination.

This World Hepatitis Day, let us reinvigorate our determination to protect the health and well-being of our nation. By joining forces, we can turn the tide against viral hepatitis and build a healthier, more resilient South Africa for generations to come. The fight against viral hepatitis starts with each one of us, and together, we can make a difference.

Professor Simnikiwe Mayaphi is HOD and Associate Professor in the Department of Medical Virology at the University of Pretoria.