What Is Hepatitis B and Why Is It Called the 'Most Deadly' Hepatitis?
Hepatitis B is a viral infection of the liver caused by the hepatitis B virus (HBV). In Hong Kong, approximately 1 in 20 people carries the virus, totaling around 410,000 individuals. Alarmingly, 40% of them are completely unaware of their infection, and 70% are not receiving appropriate medical follow-up care.
Hepatitis B is considered the most deadly of all hepatitis variants because it often goes undetected. According to Dr. Loey Mak Lung-yi, a specialist in gastroenterology and hepatology, the virus can silently damage the liver for decades without producing noticeable symptoms, gradually leading to cirrhosis and liver cancer. Globally, hepatitis B accounts for roughly 1.1 million deaths per year.
Transmission Routes: Mother-to-Child Accounts for Over 90%
In Hong Kong, more than 90% of chronic hepatitis B cases result from mother-to-child transmission. The virus is nearly 100 times more infectious than HIV and about 10 times more infectious than hepatitis C. It can survive on surfaces outside the body for at least seven days and still cause infection.
Other transmission routes include: sharing razors, toothbrushes, or nail clippers; unsafe piercings or tattoos; unprotected sex; and consuming contaminated food or water in endemic areas.
The 'Sneaky' Nature of Hepatitis B: Silent Latency and Relapse Risk
The hepatitis B virus is remarkably 'sneaky'—it can hide in 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 during chemotherapy for cancer.
Dr. Wong Sze-man, a Hong Kong-based general practitioner, explains: "The challenge is its silent progression—patients can feel completely fine for decades while the virus silently replicates." Approximately 15% to 40% of untreated chronic hepatitis B carriers will eventually develop liver complications such as cirrhosis and hepatocellular carcinoma (liver cancer).
Warning Signs and Regular Monitoring
Although hepatitis B often shows no early symptoms, you should be alert to the following signs: abnormal fatigue, yellowish skin or eyes (jaundice), abdominal discomfort, and loss of appetite.
For confirmed carriers, Dr. Mak recommends regular surveillance with an ultrasound scan and blood tests every six months to detect early liver cancer, allowing for curative treatment such as surgical resection.
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.
Eliminating Hepatitis Stigma: Scientific Understanding Matters
Many myths about hepatitis persist. For example, some believe hepatitis is only the result of drug and alcohol use—when in reality, mother-to-child transmission is far more common. Another myth is that hepatitis C is a 'death sentence.' While that may have been nearly true once, modern oral antivirals cure more than 95% of hepatitis C infections within two to three months.
'If you feel fine, you can't have hepatitis' is also untrue. Chronic hepatitis B and C are notorious for being symptomless for years or decades while quietly damaging the liver. This is a major reason why global death tolls remain so high despite available treatments—people simply do not know they have it.
The Hong Kong government has launched a 'Hepatitis B Co-care Scheme' providing free screening at District Health Centres and subsidized management in primary care settings. The Liver Foundation, an NGO, also launched its Hepatitis Testing Express service in 2024 to offer free screening to all Hong Kong citizens.
Regular testing and proactive health management are key to protecting your liver. The Xiaoshu Health App can sync with Apple Health to track relevant indicators, helping you record liver function test results, medication reminders, and lifestyle data for more convenient and effective health management.