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Understanding hepatitis D

How is the hepatitis D virus transmitted and how can I protect myself?

The HDV is an incomplete virus, i.e. it requires the presence of the hepatitis B virus (HBV) to replicate. If transmission occurs simultaneously (HDV + HBV), it is called a simultaneous infection; if it occurs in a patient who is already chronically infected with HBV, it is called a superinfection.1

The transmission routes of these two viruses are identical. Worldwide, about 5% of people with chronic hepatitis B infection are also infected with HDV. 

There are three main routes of transmission/risk factors:

  1. Transmission at birth from mother to child 
  2. Transmission via infected blood or via body fluids. 

 Shared use of: 

  • Acupuncture needles and syringes 
  • Sharp or sharp-edged objects such as those used for tattooing and piercing
  • Hygiene items such as toothbrushes and razors 
  • Drug paraphernalia (syringes, sniff tubes)

Blood transfusions

  1. Sexual transmission (if the sexual partner has an HDV infection)1

In industrialised countries, transmission of HDV via blood is most common. Sexual transmission of HDV appears to be less pronounced than other viruses such as HBV or HIV (human immunodeficiency virus). However, in certain countries such as Taiwan, sexual transmission is the most common route of entry for HDV.2 Otherwise, HDV and HBV cannot be transmitted through water or infected food.

Chronic infection with HBV = increased risk of infection with hepatitis D virus

People with chronic HBV infection are at risk of infection with the hepatitis D virus. In areas with a high prevalence of the virus (Pacific countries, Africa), HBV usually spreads vertically (transmission from mother to child at birth) or horizontally through the blood or through sexual contact (contact with blood or infected body fluids such as vaginal secretions and semen).³

Protection against infection

If you know the transmission routes, you can protect yourself from infection. Protection against HBV infection is provided by the hepatitis B vaccination.

VHD mode of transmission with infectious blood or body fluids containing blood


  1. Farci P, Niro G. A. Clinical features of hepatitis D. Semin Liver Dis. 2012 Aug;32(3):228-36.
  2. Pascarella S., Negro F. Hepatitis D virus: an update. Liver Int. 2011 Jan;31(1):7-21.
  3. Webseite der WHO, eingesehen am 06/04/2020 online verfügbar unter : https://www.who.int/news-room/fact-sheets/detail/hepatitis-b