Are you at risk of contracting hepatitis B if you eat with others?

Renowned pathologist and Former Director of Ghana Health Service, Prof Agyeman Badu Akosa, has said that eating together with others helps in the spreading of Hepatitis B.

He explained that during group eating, people put their hands in their mouths and dip them in the back into the shared soup, mixing saliva with the soup. If someone has hepatitis B, this act can facilitate the spread of the virus. For instance, eating soupy foods like fufu, omo tuo or tuo zaafi together from one bowl can result in eaters “swallowing saliva” from each other, he said.

Prof. Akosa noted “once upon a time, we were all there, there was group participation, group eating, group everything.

“And even the eating, it was later on that I realised that this is how we spread Hepatitis B. We didn’t know that. We are all eating fufu by the time you finish, you are drinking saliva.”

“I mean five, six of you, you are doing omo tuo or you are doing fufu, what do you think you are doing, you are going in like that and then you come in, by the time you are ending you are drinking saliva, it is the easiest way to spread hepatitis B”, he said.

Prof. Akosa made these remarks while leading a discussion on practical ideas intended to improve the quality of health in Ghana at the Ghana Shippers Authority Hall at Ridge in Accra on Tuesday, May 28, 2024. Several media houses (here, here, and here) reported on this claim.

This claim has generated a lot of conversations on both traditional and social media.

Fact-Check Ghana has verified Prof Akosa’s claim and presents the facts below.

Hepatitis B Virus

The World Health Organization (WHO) describes hepatitis B as an infection of the liver caused by the Hepatitis B Virus (HBV). The infection can be acute (short and severe) or chronic (long term).

In 2022, the WHO estimated that 254 million people were living with chronic hepatitis B infection, with 1.2 million new infections occurring each year. Also, hepatitis infections have claimed 1.1 million lives worldwide as of 2022.

Mode of transmission

Ghana’s Ministry of Health, in their National Guidelines for Prevention, Care, and Treatment for Viral Hepatitis, identified four avenues through which HBV can be transmitted from an infected person to an unaffected one. They are as follows:

1. Percutaneous or mucosal exposure: This refers to transmission through direct contact with infected blood or bodily fluids, such as vaginal fluids, seminal fluids, menstrual fluids, and saliva. The transmission would be successful only if, there are:
2. • Unprotected sexual contact with an infected person
   • Re-use of contaminated needles and syringes
   • Circumcision with unsterilized instruments
   • Tattooing, body piercing, sharing razors

2. Spread from mother to child at birth (perinatal transmission)
3. Horizontal transmission (exposure to infected blood) especially from an infected child to an un-infected child during the first 5 years of life
4. Transfusion with contaminated blood and other blood products

The guidelines also stated that hepatitis B virus can survive outside the body for at least 7 days. During this period, it can still cause infection if it enters the body of an uninfected person through broken skin or mucosal linings.

Some studies conducted in Sub-Sahara Africa revealed that perinatal transmission is one of the critical means by which an individual can contract hepatitis B (See here, and here).

Can a person contract HBV from group eating?

Fact-Check Ghana found that this research paper published in the journal of the American Society for Microbiology in 1976 revealed that there is a presence of HBV in saliva.

The Canadian Center for Occupation Health and Safety also corroborated this finding. However, the Center noted that saliva contains “very low concentrations” of the HBV compared to blood. Despite this, if a person is injected with an infected saliva, it can potentially transmit the virus. However, the Centre notes that “’there are no reports of people getting hepatitis B from mouth contact with infected cardiopulmonary resuscitation (CPR) manikins, sharing utensils, or mouthpieces of musical instruments”.

Many researchers and institutions argue that the transmission of HBV through saliva lacks scientific evidence. They contended that there is no substantial data to support the claim that saliva can transfer the hepatitis B virus from one person to another including people eating from the same plate or bowl. (see here, and here)

Further supporting the argument that the hepatitis B virus is not spread through communal eating, the Pennsylvania Biotechnology Center’s Hepatitis B Foundation (HBF), a not-for-profit organization dedicated to finding a cure for hepatitis B, has stated that the virus cannot be transmitted through casual contact, such as sneezing, coughing, shaking hands, hugging, or sharing or preparing meals.

The foundation further noted that it is highly unlikely to contract HBV during most daily activities. Therefore, there is no need to separate cups, utensils, or dishes when interacting with someone who has hepatitis B.

HBF emphasized that a person can safely eat a meal prepared by or shared with an individual infected with the virus. Even hugging or kissing poses no risk of transmission unless there is an exchange of blood through bleeding gums or open sores.

The WHO agreed with HBF that HBV cannot spread by air, food or water.

To further verify Prof Akosa’s claim, Fact-Check Ghana spoke with two public health scientists. Both of whom debunked the former Director General’s assertion.

Prof. Charles Ampong Adjei public health scientist and the Executive Director of Hepatitis Alliance of Ghana told Fact-Check Ghana that “Hepatitis B Virus is not transmitted from an infected person to another through sharing cooking utensils or group meals.”

“I want Prof Akosa to provide us with epidemiological data and I mean local data that support his statement and for us to see it,” Prof Adjei demanded.

“There hasn’t been any evidence showing that it could be used as a vehicle for transmission. Until then what we know is that the virus cannot be transmitted through that” he said

Dr Arti Singh, a lecturer at the School of Public Health of the Kwame Nkrumah University of Science and Technology (KNUST) affirmed Prof Adjei’s view.

“I don’t think there is a scientific evidence to this, unless maybe somebody has an open wound or something. I wouldn’t say it’s a scientific claim”.

“Actually, food is not a mode of transmission for Hepatitis B. Hepatitis B is mostly transmitted through blood”.

Conclusion

Although several scientific studies report that HBV can be found in saliva, albeit in very low concentrations, Fact-Check Ghana found no scientific evidence validating Prof. Akosa’s claim that eating together with others who may have hepatitis B is a way to spread the disease. Therefore, the claim that communal eating can spread hepatitis B is false.