The World Health Organization classifies hepatitis B as a major global health threat, with viral hepatitis infections claiming an estimated 3,500 lives every day. That translates to roughly 1.28 million deaths per year. WHO has set a goal to eliminate hepatitis B as a public health threat by 2030, targeting a 90% reduction in new chronic infections and a 65% reduction in deaths compared to current levels. Here’s what the organization recommends for prevention, testing, and treatment.
Global Burden and Highest-Risk Regions
Hepatitis B is not evenly distributed around the world. WHO’s Western Pacific Region carries the highest rates of infection, with most countries reporting chronic infection in more than 8% of their adult population. Some Pacific island nations see prevalence as high as 25 to 30%. Sub-Saharan Africa also has a heavy burden. In these regions, the virus spreads primarily from mother to child during birth or in early childhood, which is significant because infections acquired in infancy are far more likely to become chronic than those picked up later in life.
In countries with lower overall prevalence, sexual contact is the leading route of transmission among adolescents and adults. The geographic differences shape how WHO tailors its prevention strategies: universal infant vaccination in high-burden areas, targeted testing and vaccination for specific groups in lower-prevalence settings.
How Hepatitis B Spreads
The virus travels through blood and body fluids. Virus concentration is highest in blood and serum, with lower levels found in saliva, semen, and vaginal fluids. The main transmission routes are mother-to-child during birth, sexual contact, contaminated needles (including from injection drug use), and exposure to infected blood through medical procedures, transfusions, or dialysis. Tattooing, ear piercing, acupuncture, and sharing razors or toothbrushes can also transmit the virus if equipment is contaminated.
Hepatitis B does not spread through casual daily contact and cannot be transmitted through the fecal-oral route, which distinguishes it from hepatitis A.
Who Should Be Tested
In countries where more than 2% of the general population tests positive for the hepatitis B surface antigen (HBsAg), WHO recommends that all adults be offered testing. In all settings, regardless of prevalence, the organization recommends testing for pregnant women, blood donors, anyone with signs of liver disease, and several higher-risk groups: migrants from regions where hepatitis B is common, household members and sexual partners of infected people, healthcare workers, people who inject drugs, people in prisons, men who have sex with men, sex workers, transgender people, and anyone living with HIV.
The standard screening test looks for HBsAg in the blood, using either a rapid diagnostic test or a lab-based assay. In populations where prevalence is very low (below 0.4%), WHO suggests confirming a positive result with a second test. Once someone tests positive, a follow-up test measuring the virus’s DNA levels helps determine whether treatment is needed.
Vaccination: The Core Prevention Strategy
Hepatitis B is preventable with a safe, highly effective vaccine. WHO recommends that all newborns receive their first dose within 24 hours of birth, followed by two or three additional doses spaced at least four weeks apart. The complete series produces immunity in more than 95% of infants, children, and young adults. Protection lasts at least 20 years and is likely lifelong.
The birth dose is especially critical. Infections acquired in infancy carry the highest risk of becoming chronic, so vaccinating within the first day of life is the single most important step in breaking the cycle of mother-to-child transmission. In high-burden countries, scaling up birth-dose coverage is central to WHO’s 2030 elimination targets.
Preventing Mother-to-Child Transmission
Beyond the birth dose vaccine for newborns, WHO recommends that pregnant women who test positive for hepatitis B and have high viral loads (200,000 IU/mL or above) take an antiviral medication called tenofovir during pregnancy. This is typically started in the second trimester and continued through delivery or until the infant completes the vaccination series. In studies, no transmission to infants occurred when mothers had viral loads below that 200,000 threshold, which is why the antiviral is reserved for women above it.
When Treatment Is Recommended
Not everyone with chronic hepatitis B needs antiviral treatment immediately. WHO’s 2024 guidelines identify three main situations where treatment should begin. The first is when the liver already shows significant scarring or cirrhosis, which can be assessed with simple, non-invasive tests like ultrasound-based elastography or a blood-based scoring system. The second is when the virus is actively replicating at moderate levels (above 2,000 IU/mL of viral DNA) and liver enzymes are elevated, a sign of ongoing liver damage. The 2024 guidelines lowered that viral threshold tenfold from earlier recommendations, meaning more people now qualify for treatment.
The third situation covers people with additional risk factors regardless of their viral load: coinfection with HIV, hepatitis C, or hepatitis D; a family history of liver cancer or cirrhosis; immune suppression from medications or organ transplant; diabetes; or certain kidney or blood vessel complications linked to the virus.
The preferred first-line treatments remain two antiviral medications, tenofovir and entecavir, both taken as daily pills. These drugs suppress the virus effectively and have a high barrier to resistance, meaning the virus is unlikely to develop the ability to evade them. Treatment is typically long-term, often lifelong, because stopping antivirals can allow the virus to reactivate.
HIV and Hepatitis B Coinfection
People living with both HIV and hepatitis B need a carefully coordinated treatment plan because several HIV medications also work against hepatitis B. The standard approach is to build an HIV regimen around drugs that suppress both viruses simultaneously. This dual activity is convenient, but it also means that if HIV treatment is changed or stopped, hepatitis B can flare dangerously. Any switch in HIV medications for someone with coinfection must maintain coverage against hepatitis B, either by keeping the active drugs in the regimen or adding a dedicated hepatitis B medication.
Using only a single drug with hepatitis B activity inside an HIV regimen is not recommended, because the virus can develop resistance to that drug, leaving fewer future treatment options.
WHO’s 2030 Elimination Targets
WHO’s elimination strategy rests on five service coverage targets spanning prevention and treatment. If countries meet these benchmarks, modeling suggests new chronic hepatitis B infections could drop by 90% and deaths by 65% compared to a scenario where current efforts simply continue at their present pace. The pillars include high coverage of infant vaccination (especially the birth dose), widespread testing and diagnosis, access to antiviral treatment for those who need it, prevention of mother-to-child transmission, and blood and injection safety.
Progress has been uneven. Infant vaccination coverage has improved dramatically in many countries, but access to testing and treatment remains low, particularly in low- and middle-income countries where the burden is greatest. The 2024 Global Hepatitis Report highlighted this gap, noting that the daily death toll of 3,500 people reflects, in large part, a failure to connect diagnosed individuals with available care.