Viral hepatitis is a major public health problem that is widespread throughout the world and can lead to chronic liver disease, cirrhosis, and liver cancer. Due to the fact that the disease often presents symptoms in the late stages and the majority of patients are unaware of their condition, the World Health Organization (WHO) has designated July 28 as World Hepatitis Day to raise awareness about viral hepatitis. The theme for World Hepatitis Day 2025 is “Let's Take Hepatitis Step by Step,” emphasizing the need for collaboration to eliminate economic, social, and systemic barriers, particularly stigma, and to increase access to diagnosis, treatment, and vaccination. The WHO emphasizes that increasing access to treatment services for hepatitis prevention and control is crucial in reducing the incidence of the disease and deaths, prevent new infections, reduce the incidence of liver cancer cases and deaths, thereby reducing healthcare costs, and that all countries should continue to work together to eliminate viral hepatitis, a public health problem, by 2030.
Hepatitis is, in the simplest terms, inflammation of the liver. Hepatitis is one of the most common causes of death from infectious diseases worldwide and can develop for many reasons. Viral hepatitis is caused by different types of viruses, primarily the Hepatitis A, B, C, D, and E viruses. Hepatitis B and C viruses are of particular importance as they can lead to chronic liver disease, cirrhosis, or liver cancer in the long term.
Hepatitis A is a disease that can cause outbreaks through contaminated water and food and is easily transmitted in poor hygienic conditions. While hepatitis A infection is mild in childhood, it can be more severe in older age and lead to severe liver disease and death. In our country, compliance with hygiene rules and cleanliness conditions, increased access to clean water sources, improvements in other socio-economic indicators, and the introduction of hepatitis A vaccination programs in 2012 have resulted in a decrease in the incidence of hepatitis A infection to 0.6 per 100,000 in 2024. Currently, in our country, hepatitis A vaccination is administered free of charge at health facilities to children at 18 and 24 months of age, and to individuals in at-risk groups in two doses with at least a six-month interval between doses. The hepatitis A vaccination coverage rate for the second dose in 2024 was 93.01%.
Hepatitis B and Hepatitis C;
Transfusion of infected blood and blood products Medical or dental procedures using unsterilized surgical equipment Sharing used syringes Sharing items such as razors and toothbrushes Tattooing, acupuncture, or body piercing with unsterilized instruments From mother to baby during and after birth Unprotected sexual intercourse.
The routes of transmission of the hepatitis C virus are similar to those of the hepatitis B virus, but the main route of transmission is direct contact with infected blood and blood products. However, other body fluids that have come into contact with infected blood can also be a source of transmission.
The most effective way to prevent Hepatitis B is through vaccination. In our country, the Hepatitis B vaccine was added to the routine childhood vaccination schedule as of 1998. Between 2005 and 2009, booster vaccinations and vaccinations for risk groups were implemented in schools. Immunization services are one of the most important and effective preventive health services carried out by our Ministry, and Hepatitis B vaccinations are one of our high-priority strategies under the Expanded Immunization Program. The Hepatitis B vaccine coverage rate for the third dose in 2024 was 94.62%.
One of the success indicators of the UN Sustainable Development Goals is to reduce the incidence of acute Hepatitis B in children under 5 years of age to less than 1 per 100,000. This target was achieved in our country in 2009 and is still being maintained. The number of acute hepatitis B cases in children under the age of 5, which was 370 in 1990, decreased to 45 in 2009 and to 5 in 2024. The incidence of acute hepatitis B disease in children under the age of 5 was 6.2 per 100,000 in 1990, while it was determined to be 0.1 per 100,000 in 2024. The incidence of acute hepatitis B cases in our country was 5.8 per 100,000 in 1990, while it decreased to 0.75 per 100,000 in 2024.
In our country, the hepatitis B vaccine was previously administered at birth and subsequently at 1 and 6 months as a single-component hepatitis B vaccine, as of 2025, with the transition to a 6-component combination vaccine, only a single-component hepatitis B vaccine is administered at birth, and the remaining doses of hepatitis B are completed with the hepatitis B component of the 6-component combination vaccine. The 6-component combination vaccine is administered at the end of the 2nd month, the end of the 4th month, the end of the 6th month, and the end of the 18th month. For babies born to HBsAg-positive mothers, hepatitis B immunoglobulin is administered along with the hepatitis B vaccine at birth, and a single hepatitis B vaccine is administered as the second dose at the end of the first month, followed by the 6-component combination vaccine doses. For individuals in the risk group, three doses are administered at 0, 1, and 6 months, free of charge.
There is currently no vaccine against the hepatitis C virus, but direct-acting antiviral-based treatments have been shown to achieve HCV eradication, leading to improved liver function, improved disease progression, reduced cirrhosis and related complications, and reduced development of hepatocellular carcinoma. and that these treatments have been shown to reduce mortality rates from all causes in compensated and decompensated cirrhotic patients. Hepatitis C infection treatment results in improvement in over 95% of patients. This treatment is also provided free of charge to our citizens under the general health insurance scheme.
The hepatitis D virus (HDV) only causes disease in individuals with hepatitis B virus (HBV) infection. It cannot cause infection in the absence of HBV. However, it can transform a mild HBV infection into a more severe and rapidly progressing disease. HDV infection can be transmitted through percutaneous routes, blood and blood product transfusions, and mucosal contact with infectious blood. Treatment for HDV infection is available in our country.
The hepatitis E virus (HEV) can be transmitted through the fecal-oral route (contact with feces), consumption of contaminated food or water/drinks, or person-to-person contact. Acute HEV infection during pregnancy tends to be more severe. HEV infection can be transmitted from mother to baby during pregnancy. The risk of developing severe hepatitis due to HEV infection is high in the second and third trimesters of pregnancy. It is more common in people who have undergone organ transplantation and those receiving immunosuppressive treatment. HEV infection is usually self-limiting, but people with fulminant hepatitis and symptomatic pregnant women are hospitalized for treatment.
In line with the World Health Organization's 2030 viral hepatitis elimination targets, the Turkish Viral Hepatitis Control Program (2024-2030), established by our Ministry as a continuation of the program previously implemented in line with the World Health Organization's 2030 viral hepatitis elimination targets, aims to increase awareness of viral hepatitis in the community, particularly among at-risk groups, continue educational activities to increase awareness of viral hepatitis among healthcare personnel, ensure that the community's immunity levels against hepatitis A and hepatitis B infections are increased and maintained, increasing hepatitis B and hepatitis C screening for pregnant women, establishing chronic hepatitis B and hepatitis C surveillance, continuing activities to ensure the safe use of blood and blood components, and conducting screening studies to prevent the transmission of viral hepatitis among intravenous drug users and prisoners.
The strategies identified under the Turkey Viral Hepatitis Control Program (2024-2030) are as follows:
1. Raising awareness
2. Increasing immunization
3. Preventing mother-to-child transmission
4. Strengthening viral hepatitis surveillance
5. Increasing access to treatment
6. Ensuring safe blood and blood components
7. Preventing viral hepatitis transmission among intravenous drug users and prisoners
8. Preventing healthcare-associated hepatitis
The implementation of activities identified within the scope of the Turkey Viral Hepatitis Prevention and Control Program (2024-2030) strategies aims to increase awareness of viral hepatitis in society, prevent viral hepatitis transmission, reduce the number of new cases, detect the disease early, and refer patients for treatment to prevent the development of cirrhosis and cancer.