Know your hepatitis status — and the hidden risks to liver health

Published on 21 July 2026

Many forms of hepatitis can be prevented or treated, yet some infections can remain silent for years. This World Hepatitis Day, we explore the factors that impact liver health.

At a glance

• Individuals with chronic hepatitis B and C infections may remain asymptomatic for years.
• Hepatitis A is usually transmitted through contaminated food or water or close contact with an infected person.
• To minimise the risk of hepatitis E, it is important to ensure that foods such as pork, pig liver, offal, venison, wild boar meat and shellfish are thoroughly cooked before consumption.

You may feel completely well, but still be living with hepatitis B or C without knowing it. In Singapore, an estimated 70 per cent of adults with acute hepatitis B infection are asymptomatic.

Significant liver disease can be present in hepatitis C carriers even when serum alanine aminotransferase levels, an indicator of liver damage or inflammation, are normal.

“A common misconception many people have is that hepatitis always causes jaundice or obvious symptoms,” highlighted Adj A/Prof Lee Guan Huei, Head & Senior Consultant, National University Centre for Digestive Health, National University Hospital (NUH).

“One of the main barriers to screening is that many adults do not perceive themselves to be at risk, especially because chronic hepatitis B and C are often silent for years.”

Why hepatitis screening matters

While most people agree that health screening is important and helps detect disease early, there remains a significant disconnect between awareness and action.

A local survey conducted in 2020 found that while 91.2 per cent of respondents agreed that regular screening was important for liver health, only 65.4 per cent had gone for health screening in the preceding two years. There was also less public awareness of hepatitis C, as compared to hepatitis B.

Individuals with chronic hepatitis B or C infections may not experience any symptoms for years, and many adults do not perceive themselves to be at risk.

The gap raises an important question: If we understand the value of screening, what is stopping us from getting tested?

“In clinical practice, some barriers we commonly encounter include lack of symptoms, fear of stigma, lack of awareness of transmission risks, uncertainty about where to test, cost concerns, and missed opportunities in primary care or during health screenings,” explained Adj A/Prof Lee.

In addition, the current national subsidised screening framework under the Healthier SG Screening scheme is structured around age, sex, pre-existing conditions and the date of one’s last health screening. However, viral hepatitis testing is not typically perceived by the public as part of routine health screening, which is usually associated with other chronic conditions such as diabetes, high blood pressure, cholesterol levels or common cancers.

Singapore has achieved considerable success in reducing hepatitis B transmission. Universal childhood vaccination, introduced in 1987, has substantially lowered infection rates among younger generations.

A 2008-2010 seroprevalence study showed that hepatitis B prevalence had fallen to 0.4 per cent among children and adolescents aged five to 17. Among residents aged 18 to 69 years, prevalence stood at 3.6 per cent in 2010.

Greater caution for vulnerable groups

While this is heartening news, hepatitis B screening remains important. This is especially so for some groups, including adults born before universal childhood vaccination was introduced in 1987, people with family members who have hepatitis B, injecting drug users and healthcare workers who may face occupational blood exposure.

Hepatitis C is comparatively rarer in Singapore, affecting an estimated 0.1 per cent of the population. But the overall figure masks significant differences between population groups.

While infection rates are extremely low among blood donors, they are significantly higher among groups such as haemodialysis patients, people living with HIV and people who inject drugs.

A local study found that 0.059 per cent of blood donors screened from 2011 to 2014 tested positive for hepatitis C, compared with 2.2 per cent of haemodialysis patients and 36.2 per cent of intravenous drug users living in halfway houses.

“This underscores the need for targeted screening in higher-risk groups rather than relying only on general-population screening,” said Adj A/Prof Lee.

“Second hits” to the liver

Hepatitis infections should not be viewed in isolation. In Singapore, obesity, diabetes, high cholesterol and fatty liver disease are becoming increasingly common. While these conditions do not cause hepatitis B or C, they can influence how quickly liver damage progresses in people who already have these infections.

“Obesity, diabetes, dyslipidaemia and fatty liver disease can act as ‘second hits’ in patients who already have hepatitis B or C,” explained Adj A/Prof Lee.

A large cohort study of patients with chronic hepatitis B found that those who also had metabolic dysfunction-associated fatty liver disease experienced poorer health outcomes, including lower cancer-free and transplant-free survival.

Lifestyle factors such as alcohol intake are particularly important. In patients with chronic viral hepatitis, high alcohol intake can accelerate fibrosis progression and increase the risk of cirrhosis and liver cancer.

“Regular exercise, maintaining a healthy body weight, avoiding excessive alcohol intake, and attaining good control of diabetes and cholesterol all help reduce cumulative liver injury,” emphasised Adj A/Prof Lee.

Risks that lurk in food

Food safety is paramount when it comes to minimising the risk of hepatitis A and E infections. Hepatitis A is typically transmitted through the faecal-oral route, involving exposure to contaminated food or water, or close contact with an infected person.

“Practical prevention measures include washing hands with soap and water after using the toilet and before preparing or eating food, avoiding unsafe food and water when travelling, and ensuring that food is properly cooked,” said Adj A/Prof Lee.

According to the Communicable Diseases Agency, boiling or cooking food and beverages for at least one minute to 85°C inactivates the hepatitis A virus.

For hepatitis E (HEV), individuals, especially vulnerable groups — including pregnant women, solid organ transplant recipients, people on immunosuppression, and patients with chronic liver disease — should be especially careful with raw or undercooked pork, pig liver, offal, venison, wild boar meat and shellfish.

“Solid organ transplant recipients are immunosuppressed,” said Adj A/Prof Lee. “This can make viral clearance more difficult and can allow some infections, particularly hepatitis E, to become chronic.”

To minimise the risk of hepatitis E infections, individuals should ensure pork and pig liver are thoroughly cooked before consumption.

“The Singapore Food Agency highlights undercooked pig liver as a recognised foodborne risk and advises consumers to buy meat from SFA-approved businesses, avoid raw or undercooked meat, prevent cross-contamination, cook pork and pig liver thoroughly to an internal temperature of 71°C or until there is no visible pink meat,” explained Adj A/Prof Lee.

“Hepatitis E in Singapore has been linked virologically and epidemiologically to zoonotic and foodborne transmission, and local studies have shown similarity between human HEV strains and strains detected in pig livers.”

World Hepatitis Day serves as a timely reminder that liver health should not be taken for granted. Many forms of hepatitis can be prevented, treated or cured, but only if they are detected.

Knowing your hepatitis status, adopting healthy lifestyle habits, and being mindful of foodborne risks can go a long way in protecting your liver.

In consultation with Adj A/Prof Lee Guan Huei, Head & Senior Consultant, National University Centre for Digestive Health, National University Hospital (NUH).