Routes of transmission

Hepatitis D is a viral disease with a high risk of transmission. The
virus is most commonly transmitted through blood, but it can also be found in other bodily fluids—including saliva, tears, semen, and menstrual and vaginal secretions. 

With the start of a full-scale military invasion on February 24, 2022, the situation has become more complicated due to increased risks of infection among both military personnel and the civilian population. These risks include injuries, wounds, contact with blood, and limited access to medical services and preventive care.

❗Important: Hepatitis D infection is only possible if the hepatitis B virus is present. People who do not have hepatitis B or immunity to it cannot contract hepatitis D.

Main routes of transmission

Infection most often occurs through:

• contact with infected blood or its components;
• unprotected sexual contact with an infected partner;
• use of non-sterile instruments:
  
  • for injecting or snorting drugs (needles, syringes, tubes);
  • during tattooing or piercing;
    
• sharing personal hygiene items that may have blood on them (razors, manicure tools);
• transmission from an infected mother to the child during childbirth (possible, but rare).

Sexual transmission is more common among unvaccinated people, especially those with multiple sexual partners.

At the same time, it is important to know: hepatitis D is not transmitted through everyday contact—hugs, handshakes, sharing utensils, or kissing without contact with blood. Awareness, vaccination, and safe behavior are key to protection.

Co-infection and superinfection

There are two ways of infection:

• Simultaneous infection (co-infection) — infection with hepatitis B and D viruses at the same time. In many cases, recovery is possible without the infection becoming chronic.
  
• Superinfection is infection with the hepatitis D virus in the presence of pre-existing hepatitis B. This is the most severe form of the disease, which in most cases progresses to a chronic form and more rapidly leads to cirrhosis and liver cancer.
  

The following groups are at increased risk of co- or superinfection with hepatitis D:

• people with chronic hepatitis B;
• people who are not immune to hepatitis B (have not had the disease and have not been vaccinated);
• people who use drugs by injection or snorting;
• people with HIV or hepatitis C;
• patients undergoing hemodialysis;
• men who have sex with men;
• sex workers;

We’re here to help you navigate these steps calmly and clearly—from testing to the next steps.