The Silent Hepatitis Crisis: 3.4 Million South Africans Have Hepatitis B

Only if you were born from 1995 onwards. South Africa added the hepatitis B vaccine to its childhood immunisation schedule in April 1995, given at 6, 10 and 14 weeks, and there has never been a catch-up programme for people born before that. If you were born before 1995 in South Africa, you almost certainly received no hepatitis B vaccine as a baby, whatever your family could afford at the time.

It can. Protection from childhood vaccination is long lasting for most people, but not everyone, and recorded coverage in South Africa stayed below 90 per cent for two decades after the vaccine was introduced, so some people were never fully vaccinated in the first place. In one study of health-care students at a South African university, 56 per cent had hepatitis B surface antibody levels below the protective threshold before being given a booster. Assuming you are covered because you were vaccinated as a baby is not safe. A hepatitis B surface antibody test, R400 at Epicentre, settles it.

Immunity is measured by a hepatitis B surface antibody test, written as anti-HBs. This is a different test from the HBsAg test, which shows whether you currently have hepatitis B rather than whether you are protected against it. Epicentre offers the hepatitis B surface antibody test at R400, with no doctor's referral, so if you want to know whether your childhood vaccination is still protecting you, that is the test to ask for.

Yes. Chronic hepatitis B is one of the causes of raised ALT or AST on a liver function test, and it is easy to miss in someone who drinks little or nothing and looks well. Fatty liver, medication, alcohol and several other conditions can also raise these enzymes. If your liver results came back abnormal, a hepatitis B and C blood test is a reasonable next step, and a doctor should interpret the full picture.

Usually not. Most annual wellness panels and full-body health checks cover liver enzymes, cholesterol, glucose, thyroid and related markers, but they do not include a hepatitis B surface antigen test. A normal wellness report therefore does not rule out hepatitis B. It has to be requested as its own test.

Yes, if equipment that has touched blood is reused without proper sterilisation. Hepatitis B survives outside the body far longer than many people expect, so tattooing, piercing, and cosmetic or nail procedures carry a risk wherever instruments are not properly sterilised between clients. Reputable studios that use single-use needles and sterilised equipment are a much lower risk.

Yes, and in South Africa that is the usual story. The main route of transmission here has been spread between young children, with most infections happening before the age of five, along with transmission from mother to child around birth. Hepatitis B also passes through blood, shared razors or toothbrushes, reused needles and unsterilised equipment. A hepatitis B diagnosis says nothing about how somebody has lived.

It can be sexually transmitted, and it passes through sexual contact more easily than HIV, but calling it an STI misses most of the picture in South Africa. Here the majority of infections were acquired in early childhood, either around birth or through ordinary contact between young children, long before sex was ever a factor. It also spreads through blood, shared razors or toothbrushes, and unsterilised equipment. A hepatitis B diagnosis says nothing about how somebody has lived.

Kissing is not considered a usual route of transmission. Hepatitis B is found in saliva at much lower levels than in blood, and ordinary social kissing is not regarded as a meaningful risk. The virus spreads through blood and body fluids, so the routes that matter are birth, contact between young children, sexual contact, shared razors or toothbrushes, and reused needles or unsterilised equipment.

Decades. Chronic hepatitis B often causes no symptoms at all for twenty or thirty years while it quietly affects the liver, which is why so many people are only diagnosed once damage has already been done. Feeling completely well is not evidence that you do not have it, and a blood test is the only way to know.

It depends on when you were infected. Most healthy adults who catch hepatitis B clear it themselves within about six months and develop lifelong immunity. Infants and young children usually do not: infection acquired in early childhood becomes long term in the large majority of cases. Since most hepatitis B in South Africa was acquired in early childhood, assuming it will clear on its own is not safe.

Chronic hepatitis B can usually be controlled and monitored rather than cured, although research into curative treatment is advancing. Hepatitis C, by contrast, is curable in most cases with a short course of treatment from a doctor. Epicentre is a diagnostic laboratory and does not provide treatment, so any decision about care belongs with your doctor. What matters from our side is that neither can be managed until it has been found.

Hepatitis A spreads through contaminated food and water and is usually a short illness that resolves on its own. Hepatitis B and hepatitis C spread through blood and body fluids and can both become long-term infections that quietly damage the liver. There is a vaccine for hepatitis A and hepatitis B, but not for hepatitis C. Our full guide to viral hepatitis in South Africa covers each type in detail.

HBsAg stands for hepatitis B surface antigen. A positive result means the hepatitis B virus is present in your blood at the time of testing. It does not tell you on its own whether the infection is recent or long standing, or how much your liver has been affected, so a doctor will usually arrange further tests to establish that. It is not an emergency, but it does need medical follow-up.

HBsAg, the surface antigen, is part of the virus itself, so a positive result means you currently have hepatitis B. Anti-HBs, the surface antibody, is made by your immune system, so a positive result means you are protected, either from vaccination or from clearing a past infection. They answer opposite questions, and a negative HBsAg result does not mean you are immune. Epicentre offers both: HBsAg within the Hepatitis B and C Panel at R538, and the surface antibody test at R400.

It depends on your question. If you want to know whether you currently have hepatitis B, you need the surface antigen test, HBsAg, which Epicentre runs alongside a hepatitis C antibody test in the Hepatitis B and C Panel at R538. If you want to know whether your childhood vaccination still protects you, you need the surface antibody test, anti-HBs, at R400. If you want both answers, they can be taken from the same blood draw. Neither requires a doctor's referral.

National Department of Health viral hepatitis guidelines estimate a hepatitis B surface antigen prevalence of about 6.7 per cent, which works out to roughly 3.4 million people. That makes South Africa one of the highest burden countries in the world. The figure is the accepted national estimate rather than a fresh nationwide measurement, so treat it as an order of magnitude rather than an exact count.

No. The hepatitis B blood test needs no fasting and no preparation, so you can walk in and have it done at any time of day. If you are combining it with a wellness or metabolic panel, some of those markers do require fasting, so check when you book.

No. Epicentre is a walk-in laboratory, so you can book a hepatitis B and C blood test yourself with no doctor's referral, at branches in Cape Town, Johannesburg and Durban. The Hepatitis B and C Panel is R538, results come back by email in 2 to 5 days, and students and pensioners get 10 per cent off.

Take your result to a doctor, who will assess your liver and decide what monitoring or care you need. Epicentre is a diagnostic laboratory and does not provide treatment. We can run the follow-up test that World Health Organization guidance recommends for anyone who is HBsAg positive, the hepatitis D antibody test, because hepatitis D only occurs in people who already have hepatitis B and makes the illness more serious.