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Anthea Rowan

David, who is in his forties and works in finance in Hong Kong, does not remember a life without hepatitis B, a viral infection of the liver.
“I have been a … carrier for as long as I can remember,” he says. “I found out early on as a child since I was born with it – my mother is a carrier, too.”
David’s experience is far from unusual in Hong Kong. According to Dr Loey Mak Lung-yi, a specialist in gastroenterology and hepatology, mother-to-child transmissions account for more than 90 per cent of chronic hepatitis B virus (HBV) cases in the city.
About 410,000 people in Hong Kong have hepatitis B, according to the government’s Viral Hepatitis Action Plan. Alarmingly, 40 per cent are completely unaware of their infection and 70 per cent are not receiving appropriate medical follow-up care.
Or as Hong Kong-based general practitioner Dr Wong Sze-man puts it: “When you take transport during rush hour and see 20 people, one of them is infected and is a silent carrier of the virus.”

The fact that so many people living with chronic hepatitis B infection are unaware of the condition puts David – who has known his hepatitis status his whole life – in an ironically fortunate position.
He has had regular blood tests for years, and consults a doctor every three to six months. He takes medication to keep the condition in check and looks out for warning signs, such as if he experiences abnormal levels of fatigue or his skin or eyes turn yellowish.
Aside from his regular checks, David makes sure he eats a balanced diet and exercises regularly. Hepatitis B is just another manageable part of his life and not his whole life – his choices around diet and exercise are “very much a lifestyle choice instead of doing these consciously to keep the disease at bay”.
Hepatitis B is the ‘most deadly’ variant
Wong says that hepatitis B is an ongoing concern, particularly in endemic regions like Hong Kong. It is generally considered the most deadly of all the hepatitis variants because it often goes undetected. It accounts for roughly 1.1 million deaths a year globally, mostly from cirrhosis and liver cancer that develop slowly, years or decades after chronic infection takes hold.
In Hong Kong, chronic hepatitis B infection is the leading cause of liver cancer, which is the city’s fifth most common cancer and third leading cause of cancer death.
Hepatitis B is nearly 100 times more infectious than HIV and about 10 times more infectious than hepatitis C. It can survive outside the body on surfaces for at least seven days and still cause infection.

It is also very sneaky: it can hide in your liver cells for life. Even people who successfully fight off the infection can technically still carry a dormant trace, which may reappear with a vengeance if their immune system is suppressed – such as if they are undergoing chemotherapy treatment for cancer.
“The challenge … is its silent progression and patients can feel completely fine for decades while the virus silently replicates,” Wong says. “Around 15 per cent to 40 per cent of untreated chronic hep B carriers will eventually develop liver complications such as cirrhosis [liver scarring] and hepatocellular carcinoma [liver cancer].”
A feature of chronic HBV infection is that it can lead to liver cancer without apparent damage in livers without cirrhosis. One of the most important measures to reduce liver cancer deaths related to chronic HBV infection, says Mak, is regular surveillance, with an ultrasound scan and blood tests every six months to detect early liver cancer. This will allow for treatment aimed at curing it, such as resection – surgically removing a diseased part of the organ.
The Hong Kong government has started a “Hepatitis B co-care scheme”, says Mak, and encourages eligible people to receive free-of-charge screening at District Health Centres and subsidised management in primary care settings.
In addition, the Liver Foundation – an NGO that promotes liver health awareness and helps prevent liver diseases – launched its Hepatitis Testing Express service in 2024 to provide free screening to all Hong Kong citizens.

There is still a lot of stigma around hepatitis because of a lack of education. Many myths prevail, for example that hepatitis is only ever the result of drug and alcohol use rather than – as Mak is at pains to point out – much more often a mother-to-child infection.
Another myth is that the hepatitis C form is a “death sentence”. While that might have been nearly true once, modern oral antivirals cure more than 95 per cent of hepatitis C infections within two to three months.
“If you feel fine, you can’t have hepatitis” is also untrue. In fact, chronic hepatitis B and C are notorious for being symptomless for years or decades while quietly damaging the liver. This is a big reason why global death tolls stay so high despite available treatments: people just do not know they have it.
Wong’s 6 golden rules for liver protection

Vaccinate: Check your antibodies for hepatitis A and B, especially before travelling.


Practice hygiene: Never share razors, toothbrushes or nail clippers.


Ensure safe piercings/tattoos: Confirm single-use, sterile equipment is used.


Watch food and water overseas: Avoid raw shellfish, tap water, and unpeeled fruits and vegetables in endemic areas.


Practice safe sex: Use barrier protection.


Moderate alcohol: Avoid excessive drinking or unverified herbal supplements that strain liver function.


From A to G: the medical detective story behind hepatitis
The word “hepatitis” comes from the Greek “hepar/hepat” for liver and “itis” for inflammation, so “liver inflammation.” It is a description of the condition, not a specific virus – several unrelated viruses (and other causes like alcohol, autoimmune disease or toxins) can all cause that inflammation.
Five types of the hepatitis virus affect humans: A, B, C, D and E. A sixth, G (GBV-C), is sometimes listed but, as Mak says, it is not a well-recognised entity as it does not seem to cause disease in humans.
Confusingly, the A, B, C, D and E do not reflect their order of discovery. Before any virus was isolated, doctors recognised two clinically distinct forms of hepatitis: one spread through contaminated food and water, the other through blood.
In 1947, British hepatologist Dr Frederick “Frank” O. MacCallum named these “hepatitis A” and “hepatitis B”, years before either virus was actually pinpointed. So when American geneticist Dr Baruch Blumberg identified the “Australia antigen” in 1967 while researching unrelated genetic blood markers, it inherited the name hepatitis B, once confirmed as the culprit behind serum hepatitis. Hepatitis A was identified in 1973 by American virologist Dr Stephen Feinstone at the US National Institutes of Health.
Italian doctor Mario Rizzetto identified hepatitis D in 1997 as a “defective” virus that could only infect people who already had hepatitis B. Hepatitis E was identified in 1983 after Russian virologist Dr Mikhail Balayan deliberately infected himself with a suspected sample to prove it caused disease; like hepatitis A, it is caused by consuming undercooked foods and unclean water.

Hepatitis C came last, in 1989, having spent years as a placeholder diagnosis – “non-A, non-B hepatitis” – until British scientist Michael Houghton’s team finally isolated it from infected blood.
Blumberg won the Nobel Prize in Physiology or Medicine in 1976 for his work in identifying hepatitis B. He went on to develop the first hepatitis B vaccine, which he and his colleague, Irving Millman, refused to patent. World Hepatitis Day marks Blumberg’s birthday, July 28.
His decision not to restrict licensing of the vaccine proved an especially important and altruistic move as hepatitis B is by far the most widespread of the chronic, blood- and sexually-transmitted forms.
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What is hepatitis B? The viral infection 1 in 20 Hongkongers has, with many unaware

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Lifestyle

Health & Wellness

Health

Hepatitis B is a viral liver infection that can cause cirrhosis and liver cancer. A vaccine exists, but many don’t know they are infected


Hepatitis B is a viral liver infection that can cause cirrhosis and liver cancer. A vaccine exists, but many don’t know they are infected.


Disease

Medicine

Cancer

What is hepatitis B? The viral infection 1 in 20 Hongkongers has, with many unaware

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Hepatitis B is a viral liver infection that can cause cirrhosis and liver cancer. A vaccine exists, but many don’t know they are infected

Hepatitis B is a viral liver infection that can cause cirrhosis and liver cancer. A vaccine exists, but many don’t know they are infected