Dear Editor,
We appreciate Dr. Kim and the coauthors for their interest in our paper and for providing insightful comments [1,2]. The authors analyzed the prevalence and awareness of hepatitis B and C in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES) data for the period 2012–2022, with a focus on the differences in awareness according to fibrosis stages. Their weighted prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, determined by hepatitis B surface antigen (HBsAg) and anti-HCV positivity, was 3.2% and 0.7%, respectively, while the HBV prevalence in the KNHANES data (among individuals aged 19 years or older) showed a remarkable decrease from 4.1% in 2012 to 2.5% in 2022. In the letter, the authors described HBV prevalence in the population aged 18 years or older, which should be corrected to 19 years or older.
The authors showed that the weighted prevalence of the awareness of liver disease among individuals with HBV infection was 21.1% (95% confidence interval [CI] 18.9–23.5), while the prevalence of awareness among individuals with HCV and HCV-related advanced fibrosis was 17.3% (95% CI 13.6–21.7) and 37.1% (95% CI 26.7–48.9), respectively. These results highlight the significantly suboptimal awareness and offer valuable insights with crucial data.
A questionnaire survey conducted from 2012 to 2014 among 5,017 randomly selected rural residents in Korea showed that the awareness rates for hepatitis B and C were 48.1% and 28.1%, respectively [3]. The study also demonstrated that individuals with higher education and income levels had higher awareness, a tendency similar to that observed in studies conducted in the United States [3,4]. In another study analyzing KNHANES data between 2012 and 2015, the anti-HCV prevalence was 0.66%, the positivity rate of HCV RNA among anti-HCV-positive individuals was 33.5%, and only approximately 20% of HCV-infected individuals were aware of their infection status (15.2% and 30.5% of anti-HCV- and HCV RNA-positive individuals, respectively) [5]. These findings were comparable to those of the work described in the letter.
Awareness was defined as a response of “yes” to the question, “Have you ever received a clinical diagnosis of hepatitis B or C from a physician,” which was posed to determine the awareness of a hepatitis diagnosis. If the patients thought they were just a “healthy virus carrier,” the response may not be “yes.” Because KNHANES measures awareness based on survey responses, these results may underestimate the actual awareness levels. However, despite the use of similar methodologies, the awareness rates in Korea were still much lower than those in the United States (awareness rates of hepatitis B and C were 33.9% and 55.6%, respectively) [4]. According to the Global Hepatitis Report 2024, only 13.4% of the 254 million people living with chronic hepatitis B worldwide had been diagnosed, while only 36% of people living with hepatitis C were aware of their infection [6].
To align with the World Health Organization (WHO)’s 2030 target for eliminating viral hepatitis as a major public health issue, the goals of which are reducing the incidence and liver-related mortality by 90% and 65%, respectively, it is essential to maintain diagnosis rates above 90% and treatment rates above 80% [7,8].
To improve awareness, public campaigns and increased attention from healthcare professionals are essential. Furthermore, it is necessary to educate both the public and medical practitioners about viral hepatitis while also establishing comprehensive clinical guidelines and advanced training systems for primary care providers. Integrating viral hepatitis screening into routine health check-ups is also crucial. Currently, in South Korea, hepatitis B screening (HBsAg and anti-HBs) is performed at the age of 40 years, and starting in 2025, hepatitis C antibody testing will be introduced for individuals aged 56 years. Considering that health check-ups were the most common reason for HCV testing (58.5%) in previous surveys [9], these changes are expected to significantly boost awareness and facilitate treatment, ultimately reducing incidence and liver-related mortality.
Integrated and continuous support is needed for the elimination of viral hepatitis. This includes improving the management systems for patients with hepatitis, establishing a comprehensive database, formulating long-term national strategies, and addressing barriers through continuous support and improvement efforts. In line with these efforts, the Korea Disease Control and Prevention Agency established the first national strategic plan for viral hepatitis B and C control in 2023. Dr. Kim and the coauthors’ data highlight the urgency of these actions, emphasizing the urgent need to improve awareness so as to meet the WHO 2030 target.
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