Hepatitis is an inflammation of the liver caused by viral infections, autoimmune conditions, or liver toxicity of different origin (drugs, alcohol, pregnancy, shock, or metastatic disease). Viral hepatitis is the most common cause of hepatitis globally. While several strains of the hepatitis virus (mainly A, B, C, D, and E viruses) result in liver inflammation, it is estimated that more than 300 million people worldwide live with types B and C. Hepatitis B and C infection can become chronic and cause cirrhosis and liver cancer, resulting in more than 1.3 million deaths every year. Most people living with hepatitis B or C remain unaware of their condition due to limited access to testing and the lack of symptoms in the early stages of the disease.
July 28th marks World Hepatitis Day, and this year’s theme, “Hepatitis: Let’s Break It Down", calls for more concrete actions to break down barriers holding us back from a hepatitis-free world.
Significant progress has been made in the prevention, diagnosis, and treatment of viral hepatitis—including the availability of vaccines, effective therapies for hepatitis B, and a cure for hepatitis C—alongside improved data coverage and declining medicine costs. However, with only five years remaining to meet the WHO’s 2030 target of eliminating viral hepatitis as a public health threat, major global challenges persist, particularly in ensuring equitable access to vaccination, screening, testing, and treatment, and overall progress is beginning to stagnate while deaths are increasing (1).
Here, we feature research publications across Springer Nature along with a range of comments on this year’s objectives and novel approaches to treatment and prevention that could support the global efforts to achieve the elimination goal.
Testing and prevention
Early diagnosis of hepatitis B and C is crucial, as it enables timely access to treatment, significantly reduces long-term health complications, and helps stop further transmission by breaking existing infection chains.
Current testing programs for blood-borne viruses (BBVs) such as Hepatitis B and C viruses often rely on broad approaches that lead to unnecessary testing and missed diagnoses. To address this, a new machine learning-assisted program—co-designed with people affected by BBVs and piloted in GP practices—uses health record data to more accurately identify at-risk individuals, proving both feasible and effective in increasing diagnosis rates (2) (ongoing study registered at ISRCTN).
A key preventive measure is to eliminate the vertical (mother-to-child) transmission of viral hepatitis B via routine screening, antiviral prophylaxis of pregnant women with hepatitis B, and administration of hepatitis B birth-dose vaccination, especially in regions with a high disease burden and high-risk or underserved populations (indigenous populations, mobile and migrant populations, people who inject drugs, people in prisons and other closed settings, sex workers and gay men and other men who have sex with men).
A study published in Nature Medicine reports on the successful real-world implementation of comprehensive interventions to prevent hepatitis B mother-to-child transmission (MTCT), achieving consistently low transmission rates across diverse settings and offering a scalable model for national and global elimination efforts (3).
Additional efforts in the field of antenatal testing for hepatitis B, HIV, and syphilis are currently made to develop and test the effectiveness, cost-effectiveness, acceptability, fidelity and reach of a Continuous quality improvement (CQI) intervention in Indonesia (4) (ongoing study registered at ISRCTN).
A recent editorial in BMC Medicine highlights the importance of early testing, timely treatment, and vaccination to protect maternal and infant health and underscores the necessity of region-specific strategies and global initiatives like the WHO’s Triple Elimination Initiative to combat hepatitis (5).
Despite being effective in reducing mortality and costs, the coverage of the hepatitis B birth dose remains low, especially in the African Region, which has the highest prevalence of hepatitis B. The coverage of the hepatitis B birth dose varies between 18% in the African Region and 80% in the Western Pacific Region (1).
Vaccination strategies and coverage are essential pillars in the global effort to eliminate hepatitis, serving as powerful tools to prevent infection and reduce disease burden. A crucial targetable population is represented by individuals with chronic liver disease (CLD) who might face a higher risk of severe outcomes if infected with Hepatitis A, prompting national guidelines to recommend vaccination for this group. An ongoing study aims to assess hepatitis A vaccination coverage and its predictors among adults with CLD in English primary care, analyzing differences by sociodemographic factors, liver disease type, complications, and comorbidities (6).
Treatment and Novel Targets
While vaccination is available only against hepatitis B, highly effective treatments are available for both hepatitis B and C infections, with short-course curative direct-acting antivirals (DAAs) for hepatitis C and long-term antiviral treatment for people with chronic hepatitis B infection. Although current treatments can effectively suppress hepatitis B virus replication, they rarely result in a functional cure.
A comment in Nature Reviews Gastroenterology & Hepatology highlights the urgent need for new direct-acting antiviral drugs (nucleos(t)ide analogues, NUCs) that can potently suppress hepatitis B virus replication, offering the potential for finite treatment, broader eligibility, and improved long-term outcomes (7).
Ongoing research is focused on identifying new therapeutic targets to prevent or mitigate liver damage, aiming to create a critical window for cancer prevention in individuals living with hepatitis viruses.
In a mouse model, it was shown that the hepatitis B virus enhances liver cancer risk through interaction with environmental carcinogens, specifically the tobacco smoke carcinogen diethylnitrosamine. With IL-33 signaling and regulatory T cells implicated in this process, further experiments in both mice and humans showed that IL-33 inhibitors—such as the cholesterol-lowering medication pitavastatin—may offer a promising preventive strategy for individuals living with hepatitis B. The article reporting these findings is available at Nature Communications (8).
Further investigations into the role of key molecular mediators pinpointed annexin A2 (ANXA2) and highlighted the upregulation of ANXA4 during chronic hepatitis B infection. ANXA4 appears to inhibit viral replication and liver damage through autophagic regulation of MCM2, with elevated levels also correlating with better responses to interferon therapy — positioning it as a promising therapeutic target and prognostic biomarker (9).
While DAAs have revolutionized the treatment of the hepatitis C virus, one of the remaining challenges is re-engaging individuals previously diagnosed with hepatitis C who are not currently in care. A national patient re-engagement initiative in England identified 55,329 individuals with positive HCV results, revealing 13.4% received treatment post-exercise. Findings indicate significant unengaged populations and suggest improvements for future outreach efforts to enhance treatment access (10).
Patient outcomes & experiences
Hepatitis B affects millions globally, yet many face stigma and discrimination, impacting their social and professional lives. A publication in BMC Public Health addresses the lack of formal documentation on hepatitis B-related discrimination, aiming to identify where and how such discrimination occurs (11). Researchers launched an online registry to collect data from individuals worldwide, using a survey to capture demographic and discrimination-specific information. Analysis revealed that discrimination is prevalent in employment, education, and healthcare settings, with significant emotional and economic impacts on affected individuals. For instance, many reported being denied work visas or employment due to their hepatitis B status, despite being healthy. These findings highlight the urgent need for education and policy enforcement to protect individuals from discrimination. Future research should explore the economic burden of such discrimination and advocate for comprehensive protective measures to support those living with hepatitis B. One of the authors, Dr Freeland, discusses the broader relevance of these findings in a blog post here.
Hepatitis B virus infection poses a particularly significant health challenge among migrants in Europe, who often originate from regions with high hepatitis B virus prevalence. The relationship between migrant status and mortality risk in individuals with chronic hepatitis B infection is the focus of a study in BMC Global and Public Health. Migrant individuals with chronic hepatitis B exhibit lower all-cause mortality rates compared to non-migrants, due to younger age and healthier behaviors, although liver-related mortality risks remain similar after adjustments for various socio-behavioral variables (12).
In line with the goal of improving access to care for underserved populations, a recent publication in Harm Reduction Journal explores the critical role of community pharmacies in providing sterile syringes to people who inject drugs (PWID) in Arizona, highlighting the impact of stigma and pharmacy discretion on syringe sales (13). In this blog post, Dr Meyerson —one of the study’s authors—builds on the findings to advocate for a syringe standing order as a key measure to prevent HIV and hepatitis C.
Strategies and Priorities
As the global community marks World Hepatitis Day, two recent pieces underscore the urgent need to address persistent and often overlooked barriers to hepatitis elimination. A Nature Reviews Gastroenterology & Hepatology editorial highlights critical gaps in diagnosis, vaccination coverage, and stigma reduction, particularly in regions like Africa, where monitoring and access to care remain limited. Despite the availability of effective hepatitis B vaccines and curative treatments for hepatitis C, uneven access continues to stall progress toward WHO’s 2030 elimination goals (14).
Complementing this, a perspective article on BMC Global Public Health focuses in particular on the African context, where hepatitis B affects over 82 million people. It calls attention to the lack of diagnostic infrastructure, the need for culturally sensitive communication, and the potential of integrating hepatitis B care into existing HIV programs. The authors advocate for simplified, decentralized care models and a “Treat-all-except” strategy to expand treatment access and reduce liver-related mortality (15).
Conclusions
While the current pace of progress toward hepatitis elimination can be discouraging, there is reason for hope. Proven strategies exist—and they work. What’s needed now is the collective will to implement them. Together, the insights shared here emphasize that eliminating hepatitis requires not only medical innovation but also systemic changes—integrated care, equitable resource distribution, and community-driven approaches—to ensure no one is left behind.
Related blog posts
References
(1) 2024 Global Hepatitis Report - WHO. [Accessed: July 25, 2025]. https://www.globalhep.org/sites/default/files/content/resources/files/2024-04/2024%20Global%20Hepatitis%20Report%20-%20WHO.pdf
(2) Digitally enhanced targeted testing for HIV, hepatitis B and hepatitis C in primary care (TARGET-ID): feasibility study https://doi.org/10.1186/ISRCTN10073032
(3) Yin, X., Wang, W., Chen, H. et al. Real-world implementation of a multilevel interventions program to prevent mother-to-child transmission of HBV in China. Nat Med 30, 455–462 (2024). https://doi.org/10.1038/s41591-023-02782-x
(4) Continuous quality improvement for antenatal HIV, syphilis and hepatitis B testing in Indonesia https://doi.org/10.1186/ISRCTN11251878
(5) BMC Medicine. Safeguarding mothers and newborns: the urgent need to address hepatitis during pregnancy. BMC Med 21, 284 (2023). https://doi.org/10.1186/s12916-023-03006-2
(6) Hepatitis A vaccination coverage amongst people with Chronic Liver Disease in England (HEALD): protocol for a retrospective cohort study https://doi.org/10.1186/ISRCTN11919759
(7) Block, T.M., Guo, JT., Zoulim, F. et al. New potent HBV replication inhibitors for the management of chronic hepatitis B are needed. Nat Rev Gastroenterol Hepatol 22, 150–151 (2025). https://doi.org/10.1038/s41575-025-01037-z
(8) Huang, M., Wang, D., Huang, J. et al. Hepatitis B virus promotes liver cancer by modulating the immune response to environmental carcinogens. Nat Commun 16, 5360 (2025). https://doi.org/10.1038/s41467-025-60894-z
(9) Yang, L., Liu, X., Zhen, L. et al. ANXA4 restricts HBV replication by inhibiting autophagic degradation of MCM2 in chronic hepatitis B. BMC Med 22, 521 (2024). https://doi.org/10.1186/s12916-024-03724-1
(10) Etoori, D., Simmons, R., Desai, M. et al. Results from a retrospective case finding and re-engagement exercise for people previously diagnosed with hepatitis C virus to increase uptake of directly acting antiviral treatment. BMC Public Health 24, 2427 (2024). https://doi.org/10.1186/s12889-024-19919-3
(11) Freeland, C., Qureshi, A., Wallace, J. et al. Hepatitis B discrimination: global responses requiring global data. BMC Public Health 24, 1575 (2024). https://doi.org/10.1186/s12889-024-18918-8
(12) Lotto, M., Ramier, C., Carrat, F. et al. Mortality risk in migrant and non-migrant individuals with chronic hepatitis B virus infection: a French hospital-based cohort study (ANRS CO22 HEPATHER). BMC Glob. Public Health 3, 58 (2025). https://doi.org/10.1186/s44263-025-00173-7
(13) Russell, D.M., Meyerson, B.E., Mahoney, A.N. et al. Come back when you’re infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023. Harm Reduct J 21, 49 (2024). https://doi.org/10.1186/s12954-024-00943-w
(14) Viral hepatitis: breaking down barriers. Nat Rev Gastroenterol Hepatol (2025). https://doi.org/10.1038/s41575-025-01101-8
(15) Spearman, C.W., Andersson, M.I., Bright, B. et al. A new approach to prevent, diagnose, and treat hepatitis B in Africa. BMC Global Public Health 1, 24 (2023). https://doi.org/10.1186/s44263-023-00026-1