The liver, often overshadowed by the heart or brain in public consciousness, serves as the body’s chemical powerhouse. It silently orchestrates metabolism, filters toxins, supports immunity, and helps digest every meal. Its well-being is essential for life.

Yet, an inflamed liver, a condition known as hepatitis, can quietly undermine health for years before anyone notices. Malaysia faces a pressing challenge with hepatitis, especially types B and C, as new data reveals a concerning rise in cases and persistent barriers to effective control.

Hepatitis is not a single disease. It refers to inflammation of the liver tissue, which can result from viruses, alcohol, toxins or autoimmune disorders. Globally, viral hepatitis remains the most common cause. The family of hepatitis viruses includes A, B, C, D and E. Each type carries unique risks and transmission patterns.

Hepatitis A and E typically spread through contaminated food or water—a risk magnified in communities with poor sanitation. Hepatitis B, C and D are mainly transmitted through contact with infected blood or bodily fluids. This distinction matters. It shapes prevention strategies and determines which groups are most vulnerable.

Recent Ministry of Health statistics paint a sobering picture. In the last decade, Malaysia recorded nearly 50,000 hepatitis B cases and over 34,000 hepatitis C cases. Most experts agree these numbers likely understate the true burden due to under-diagnosis and limited screening in rural areas.

Acute hepatitis can come on suddenly, sometimes after a single exposure to the virus or toxin. Symptoms include jaundice (the yellowing of skin and eyes), dark urine, fatigue, appetite loss, nausea and abdominal pain. But here’s the catch: many infections start silently. The early stage might pass unnoticed or mimic everyday malaise. For some, acute hepatitis resolves without lasting effects. For others—especially those infected with hepatitis B or C—the illness quietly becomes chronic.

Chronic hepatitis is where the real danger lies. Once established, it may persist for decades. The virus continues to damage liver cells behind the scenes. Over time, this can lead to cirrhosis (scarring), liver failure or even cancer. According to the World Health Organisation (WHO), hepatitis B and C together account for more than 1 million deaths worldwide each year—most from complications like cirrhosis or hepatocellular carcinoma.

Malaysia faces a unique set of challenges in tackling hepatitis. Hepatitis B is endemic in the population. Many older adults acquired it at birth or during childhood when vaccination was not yet routine. Hepatitis C, on the other hand, spreads mostly through unsafe injections or contaminated blood products—a risk heightened in certain high-risk groups such as people who inject drugs.

Healthcare workers remain on the frontlines of exposure. They face daily risks from needle-stick injuries or accidental contact with blood. Babies born to mothers with hepatitis B are particularly vulnerable unless preventive action is taken at birth. People with multiple sexual partners also face heightened risk for hepatitis B infection.

Malaysia’s commitment to eliminate viral hepatitis as a public health threat by 2030, announced at the World Health Assembly in 2016, reflects global momentum. Yet, progress demands more than policy declarations. Earlier reports from the Ministry of Health highlight three major hurdles: limited public awareness, patchy access to healthcare in remote regions, and social stigma that discourages testing.

Vaccination remains the strongest weapon against hepatitis B. Since its inclusion in the National Immunisation Programme in 1989, all Malaysian newborns receive their first dose within 24 hours of birth—an intervention proven by research to drastically reduce mother-to-child transmission. Pregnant women diagnosed with hepatitis B receive antiviral medicine to lower the risk of passing the virus to their babies.

No vaccine exists yet for hepatitis C. Instead, prevention hinges on safe injection practices, blood screening and public education about risk behaviours. Needle exchange programmes for people who inject drugs help reduce new infections

Screening saves lives but remains unevenly distributed across Malaysia’s diverse geography. Urban centres fare better than rural villages where healthcare infrastructure is stretched thin and awareness campaigns rarely penetrate. Experts urge routine screening for all high-risk groups including healthcare workers, blood donors and migrants.

When it comes to treatment, not every patient needs medication immediately. In some cases, especially with acute hepatitis or mild chronic disease, the immune system naturally suppresses the virus without drugs. For chronic cases where viral load is high or liver damage is evident, intervention is vital.

For chronic hepatitis B, oral antiviral medications like entecavir and tenofovir are mainstays of care. These drugs don’t cure the infection but keep it under control by stopping viral replication—thereby reducing risk of severe complications such as cirrhosis or liver cancer. Lifelong therapy is common. Peginterferon alpha injections offer another option for select patients but aren’t suitable for pregnant or breastfeeding women due to possible side effects.

Hepatitis C treatment has undergone a revolution over the past decade. The arrival of direct-acting antivirals such as sofosbuvir and daclatasvir changed everything—curing over 95% of cases in just a few months with minimal side effects.

Yet access remains an issue in Malaysia. Cost, availability and administrative hurdles can delay treatment initiation—especially outside major cities. Health authorities are working to close these gaps through partnerships with non-governmental organisations and international agencies.

Treatment side effects are generally mild but can include headache, nausea, tiredness or skin rashes. Any unusual symptom warrants prompt consultation with a doctor to avoid complications or unnecessary worries.

Living with hepatitis requires more than just medication. Patients benefit from lifestyle changes that support liver health: balanced diets rich in fruits and vegetables, regular moderate exercise and strict limitation of alcohol intake top the list of recommendations from liver specialists in journals like Hepatology International.

Co-infection is another concern—particularly for those living with HIV or another type of hepatitis virus at the same time. Experts recommend all people with hepatitis undergo testing for HIV and other types of hepatitis to ensure comprehensive care.

Prevention extends beyond medical care into everyday life choices. Sharing personal items such as razors or toothbrushes poses a real risk of spreading blood-borne viruses within households. Blood donation is strictly off-limits until a doctor confirms full recovery or cure.

Social stigma remains a stubborn barrier to progress. Many people hesitate to get tested or disclose their status out of fear they’ll be judged or ostracised at work or within their families. There is a need for continued public education campaigns that normalise testing and empower people to seek treatment without shame.

Hepatitis A and E are less worrisome in Malaysia than B and C for one key reason: they rarely become chronic illnesses and usually resolve without long-term consequences. Outbreaks still occur occasionally—often linked to contaminated food or water—but most people recover fully after a brief illness.

Every year on July 28th, World Hepatitis Day focuses attention on this silent epidemic under the theme “Let’s break it down.” The aim? To replace confusion and fear with knowledge and action so that individuals and families can protect themselves—and so that society can move closer to ending hepatitis as a public health threat.

Malaysia’s journey is far from over but progress is underway. Expanded vaccination coverage has slashed new hepatitis B infections among children. Direct-acting antivirals now offer hope for curing almost all hepatitis C patients—provided they get diagnosed early enough to benefit from treatment.

Experts stress that success will depend on sustained investment in public health infrastructure, wider access to screening and therapy across urban and rural divides, and a societal shift towards openness about liver health.

Hepatitis may be silent at first but it need not remain invisible forever. Through awareness, prevention and modern medicine, Malaysia can win this battle for its future generations—one step at a time.