Millions of Americans live with chronic hepatitis and may not know it, because it can take years to become symptomatic. The most common types of the virus, hepatitis B and C, can lead to liver failure, cancer and death. They also kill more people in Philadelphia than HIV, according to the city's health department.
An estimated 48,000 people in Philadelphia were living with hepatitis B or C in 2023, according to the health department's latest annual report. But that figure is likely an underestimate, because people without symptoms often go untested, according to Danica Kuncio, who helped compile the report.
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"But we have seen declines, and with hepatitis C, we think that … the rate of decline may be true, because there's been such incredible treatment for hepatitis C that has happened in Philly and has led to a lot of people being cured of infection, which means there's less transmission in the community," said Kuncio, the health department's viral hepatitis program manager.
Nearly 51,500 people in Philadelphia have been diagnosed with hepatitis C since 2013. In 2023, 43% of those people were living with chronic hepatitis C. That means that 57% of people diagnosed with hepatitis C over the decade either naturally cleared the virus or were cured of the disease through treatment, according to the report.
"It's not 100%," Kuncio said. "We still have work to do. But that 57% – that's a high number."
What is hepatitis?
There are six kinds of hepatitis – A, B, C, D, F and G – that all lead to inflammation of the liver, impeding its ability to clean the blood, aid in digestion and help the body store and use energy. Hepatitis A and E are usually spread through contaminated food or water. Hepatitis B, C and D are spread through contact with the blood or semen of an infected person. They also can be passed from a pregnant person to a child during birth, according to the Centers for Disease Control and Prevention. Hepatitis B is also transmitted through through vaginal fluid.
Vaccines can help prevent hepatitis A and B. People who are unvaccinated and who develop hepatitis B "can live a long life with effective treatment and support from … clinicians," Kuncio said.
Antiviral medications can treat and often cure hepatitis C.
Acute hepatitis is a designation given when someone is first infected. Most otherwise healthy adults do not experience symptoms when first infected with hepatitis B and C, and many people spontaneously clear these infections within about six months without any treatment, according to the World Health Organization. When infections last beyond six months, they are defined as chronic.
The CDC estimates that more than 2 million people in the United States have chronic hepatitis C. An estimated 880,000 to 1.89 million have chronic hepatitis B, according to the Department of Health and Human Services.
The CDC now recommends all adults be screened for hepatitis B and C at least once in their lifetime.
"We really want to push people to be advocating for themselves, to receive testing and access to care and services," Kuncio said.
Hepatitis C in Philadelphia
There were 144 acute hepatitis C infections in 2023. That total was more than three times higher than the 42 cases reported in 2013, but lower than a peak of 183 cases in 2018. Since then, rates of acute hepatitis C have generally been trending back down. The majority of acute hepatitis C cases were in people ages 30 to 39 and among people who use drugs, according to the report.
In 2023, there were 1,089 new cases of chronic hepatitis C, down from just under 3,000 in 2013. The rate of new chronic hepatitis C in 2023 was 70 per 100,000 people, compared to 189 per 100,000 people in 2013, according to the report.
Of the 23,396 Philadelphia residents living with chronic hepatitis C in 2023, the majority were male, Black or white, 25 to 64 years old, Kuncio said.
"The opioid epidemic and drug use epidemic drove our cases up, especially amongst young individuals, but we've seen some decreases over time," Kuncio said. "We think that it's because there is so much proactive treatment and prevention for helping to reduce the number of people who have hepatitis C in the community."
Hepatitis B in Philadelphia
Nearly 25,000 people in Philadelphia were living with chronic hepatitis B in 2023, the report said.
Cases of acute hepatitis B saw a gradual incline in the decade covered by the report, from five cases in 2013 to 11 cases in 2023. New infections were primarily among young people. Transmission was associated with a history of substance use and been among men who have sex with men, according to the report.
The number of newly-reported cases of chronic hepatitis B increased 42% from 2020 to 2023 but declined overall during the 10 years the report covered. Chronic hepatitis B cases decreased from more than 1,000 in 2013 to 655 in 2023.
The hepatitis B vaccine first became commercially available in 1982 but was not recommended for infants and young children until 1991 – so vaccination rates are not consistent.
"But if this was 40 years ago, those numbers (increases in hepatitis B) would be much higher, especially related to the drug use epidemic," Kuncio said. "We want to make sure people are being vaccinated, because it's just been such an incredibly effective public health tool."
The CDC has hepatitis materials available online. Click here for local information and resources.