Hepatitis B and C: How They Spread, How to Test, and What’s New in Treatment

Every year, over 3 million people worldwide get infected with hepatitis B or C. Most don’t know it until their liver is already damaged. The scary part? Both viruses are preventable or curable today-but millions still go undiagnosed and untreated. If you’ve ever wondered how these viruses spread, whether you should get tested, or if there’s real hope for a cure, here’s what actually matters right now.

How Hepatitis B and C Spread

Hepatitis B: More Contagious Than You Think

Hepatitis B isn’t spread by coughing, hugging, or sharing food. It’s spread by blood and bodily fluids. The most common way? From mother to baby during childbirth. In places like parts of Asia and Africa, up to 90% of chronic hepatitis B cases start this way. Even in low-risk countries, this is still a major source of infection.

Sexual contact is another big one. If you’re unvaccinated and have sex with someone who has hepatitis B, your risk of catching it is 30% to 60%. That’s higher than HIV. Sharing needles-even once-is a direct route. The virus can live on a needle or razor for up to seven days. That’s why sharing personal items like toothbrushes or razors can be risky, especially in households where someone is infected.

Healthcare workers are at risk too. A needlestick injury carries a 6% to 30% chance of transmission, depending on whether the source patient has high levels of the virus. It’s not common, but it happens.

Hepatitis C: Blood-to-Blood Only

Hepatitis C is simpler in how it spreads: blood-to-blood contact. No other fluids matter. The biggest driver today? The opioid crisis. In the U.S., cases jumped 71% between 2014 and 2018. Most new infections are in people under 40 who inject drugs. Sharing needles, cookers, or cotton is the main cause.

Mother-to-child transmission happens in about 5% to 6% of pregnancies. It’s rare but possible. Blood transfusions and organ transplants used to be a big risk-but since screening started in the early 1990s, that’s almost gone in developed countries.

You won’t catch hepatitis C from a toilet seat, a handshake, or kissing. It doesn’t live in saliva or sweat. If you’ve never injected drugs, never had a tattoo with unsterile equipment, and never had a blood transfusion before 1992, your risk is extremely low.

Who Should Get Tested

Hepatitis B Screening

The CDC now recommends everyone get tested for hepatitis B at least once in their life. But some groups need it more urgently:

• Anyone born in regions with high hepatitis B rates (Asia, Africa, Eastern Europe, the Pacific Islands)
• Healthcare workers and first responders
• People who inject drugs
• Men who have sex with men
• People with HIV or other sexually transmitted infections
• Anyone about to start chemotherapy or kidney dialysis
• All pregnant women

If you’re from a high-prevalence country, even if you were vaccinated as a child, you should still get tested. Vaccines don’t always work perfectly, and immunity can fade over decades.

Hepatitis C Screening

The CDC says every adult aged 18 and older should get one-time hepatitis C screening. Pregnant women need it too. That’s because many people have no symptoms for years-and by the time they feel sick, their liver is already damaged.

High-risk groups should be tested regularly:

• People who inject drugs (even once, years ago)
• People with HIV
• Those who got a blood transfusion or organ transplant before 1992
• People with abnormal liver enzyme levels
• Anyone born between 1945 and 1965 (baby boomers, who have the highest infection rates)

You don’t need to feel sick to be infected. That’s why testing is so important.

How Testing Works

Hepatitis B Testing

Hepatitis B isn’t checked with one test. It’s a panel:

• HBsAg - If positive, you’re infected. This is the first sign.
• Anti-HBc - Shows you’ve been exposed to the virus, whether past or current.
• Anti-HBs - Means you’re protected, either from vaccination or past infection.
• HBeAg and HBV DNA - Used to see how active the virus is and whether treatment is needed.

If HBsAg stays positive for more than six months, it’s chronic hepatitis B. That’s when you need to start monitoring your liver health closely.

Hepatitis C Testing

Hepatitis C testing is simpler:

• Anti-HCV antibody test - First step. Positive means you’ve been exposed.
• HCV RNA test - If the antibody test is positive, this confirms if the virus is still active in your blood.

There are also rapid point-of-care tests now. The OraQuick HCV test gives results in 20 minutes using a finger-prick blood sample. These are used in clinics, shelters, and mobile units to reach people who don’t go to hospitals.

Treatment Advances: A Revolution in Hepatitis C

Hepatitis C used to be a life sentence. In the 1990s and early 2000s, treatment meant weekly injections of interferon for up to 48 weeks. Side effects were brutal: depression, fatigue, flu-like symptoms. Only about half of patients were cured.

That changed in 2013 with the approval of sofosbuvir. Today, direct-acting antivirals (DAAs) like Epclusa and Mavyret cure over 95% of people in just 8 to 12 weeks. No injections. No hospital visits. Just pills.

These drugs work by blocking the virus’s ability to copy itself. They’re so effective that even people with advanced liver disease or HIV co-infection can be cured. Side effects? Usually mild-headache or tiredness.

The big win? Treatment is now available as generics for under $300 in countries like Egypt and India. In the U.S., prices dropped from $84,000 per course in 2014 to $24,000-$30,000 today. Many insurance plans cover it fully now.

Egypt’s success story is proof it works. In 2008, 14.7% of Egyptians had hepatitis C. By 2021, after a national screening and treatment campaign, it dropped to 0.9%. That’s 10 million people treated. It’s not science fiction-it’s real.

Hepatitis B: No Cure Yet, But Better Control

Unlike hepatitis C, there’s no cure for hepatitis B. But we can control it extremely well.

The go-to drugs are tenofovir alafenamide (TAF) and entecavir. They stop the virus from multiplying. They’re taken as one pill a day. Side effects are rare. They’re so safe, even pregnant women can take them.

These drugs don’t eliminate the virus. They suppress it. So you usually need to take them for life. But that’s enough. People on treatment have a near-normal life expectancy. Their risk of liver cancer and cirrhosis drops by over 80%.

A new hope? Functional cure. That means losing the hepatitis B surface antigen (HBsAg) from your blood. It’s rare-only 1% to 2% of people achieve this naturally each year. But new drugs are in trials:

• siRNA drugs like JNJ-3989 silence the virus’s genetic material.
• Capsid modulators disrupt how the virus builds its shell.
• Therapeutic vaccines try to train your immune system to fight the virus.

Some of these are in phase 3 trials. If they work, we could see the first functional cures for hepatitis B by 2030.

Barriers to Getting Help

We have the tools. But we’re not using them.

Only 21% of people with hepatitis C in the U.S. got treated in 2020. Why? Cost, stigma, and lack of awareness. Many people think they’re not at risk. Others fear judgment if they admit to drug use.

For hepatitis B, vaccine coverage in U.S. adults is just 66.5%. The goal is 90%. Birth-dose vaccination (given within 24 hours of birth) is still not universal in many countries. That’s why hepatitis B stays endemic.

In rural areas and among people who inject drugs, testing and treatment access is still poor. Mobile clinics and community health workers are filling the gap. In Australia, outreach programs in prisons and drug treatment centers have boosted testing by over 50% in five years.

What You Can Do Today

If you’re reading this, here’s your action plan:

1. Get tested for both hepatitis B and C. One blood test can tell you everything.
2. If you’re negative for hepatitis B and not immune, get vaccinated. Three shots over six months give lifelong protection.
3. If you have hepatitis C, talk to your doctor about DAAs. You can be cured.
4. If you have chronic hepatitis B, see a liver specialist. Don’t wait for symptoms.
5. If you use drugs, never share needles. Use clean equipment. Needle exchange programs save lives.

You don’t need to be a doctor or a public health expert to make a difference. Just knowing your status is the first step to staying healthy-and protecting others.

What’s Next

The World Health Organization wants to eliminate viral hepatitis as a public health threat by 2030. That means 90% fewer new infections and 65% fewer deaths.

We’re on track for hepatitis C. With better access to cheap generics and expanded testing, it’s possible.

Hepatitis B is harder. We need better vaccines, better treatments, and global birth-dose coverage. But progress is happening. New drugs are coming. More countries are making testing free and routine.

The message is simple: We know how to stop these viruses. Now we just need to do it.