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Chronic viral hepatitis in athletes: an overlooked population?
  1. Lung-Yi Mak1,2,
  2. Ian Beasley3,
  3. Patrick T F Kennedy2
  1. 1 Medicine, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, People's Republic of China
  2. 2 Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  3. 3 Centre for Sports and Exercise Medicine, Queen Mary College of London, London, UK
  1. Correspondence to Professor Patrick T F Kennedy, Queen Mary University of London, London E1 4NS, UK; p.kennedy{at}

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Viral hepatitis: a global health threat

Viral hepatitides (types A–E) are capable of causing human infections. While both hepatitis types A and E are transmitted by faecal–oral route and usually self-limiting, hepatitis types B, C and D viruses (HBV, HCV, HDV) are blood-borne infections that can lead to chronic liver inflammation, cirrhosis, liver cancer and death. In 2015, the WHO estimated that 1.34 million people died from HBV/HCV infection (accounting for 96% mortality from viral hepatitis), highlighting that viral liver disease is a major public health challenge.1 In 2016, the World Health Assembly called for global elimination of viral hepatitis by 2030. Worldwide and regional estimates were reported, and specific goals were set aiming to achieve 90% and 65% reduction in incidence and mortality, respectively, from viral hepatitis.1 This editorial aims to highlight public health strategies to mitigate chronic viral hepatitis that are relevant to the care of athletes.

Progress made thus far

In 2021, the WHO issued the Interim Guidance to review progress and provide a global framework for the processes and validation of elimination efforts. Over the last 5 years, although global HBV prevalence has climbed from 257 to 296 million, HCV prevalence dropped from 71 to 58 million, and the overall mortality from chronic viral hepatitis declined from 1.34 to 1.1 million.2 This progress could not have been achieved without salient interventions including HBV vaccination, blood/injection safety, diagnostic tests and treatment coverage. While HBV birth-dose vaccine coverage in Africa was once only 6% compared with 43% globally, childhood HBV vaccination coverage with three doses has since …

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  • Contributors The authors declare they have participated in the preparation of the manuscript and have seen and approved the final version. L-YM—original drafting and revision of the manuscript. IB—reviewing and editing of the manuscript. PTFK—manuscript concept and design, interpretation of literature, critical revision of the manuscript and overall study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests IB is a director at the International Concussion and Head Injury Foundation, and is medical consultant to the Global Performance Unit at City Football Group. PTFK has received research grants from Gilead Sciences; received consulting fees from Aligos Therapeutics, Antios Therapeutics, Assembly Biosciences, Gilead Sciences, GlaxoSmithKline, Janssen and Immunocore; and is the BASL HBV special interest group lead. L-YM has nothing to disclose.

  • Provenance and peer review Commissioned; internally peer reviewed.