By Michael Smith
North American Correspondent,
MedPage Today April 21, 2017
AMSTERDAM — As a global health threat, viral hepatitis has annual mortality on a par with tuberculosis and HIV, according to a new report from the World Health Organization.
The difference is that mortality for HIV and TB has been falling while the “trend for hepatitis is upwards,” according to Gottfried Hirnschall, MD, director of the UN agency’s global hepatitis program.
The key message of the report — the first to present validated global estimates of the impact of hepatitis B and C — is that hepatitis is a “major global health problem,” Hirnschall said.
The data in the report represent “the best estimates ever” of the burden of disease on a global and regional scale, Hirnschall told MedPage Today, although he cautioned that there are still gaps in information that could affect the numbers.
The report, released here at the International Liver Congress, the annual meeting of the European Association for the Study of the Liver, is a snapshot of what was known about the issue in 2015. That year:
- There were 1.34 million deaths from the consequences of chronic HBV and HCV infection, up 22% from 2000.
- 328 million people were living with viral hepatitis, including 257 million with HBV and 71 million with HCV.
- For HBV, just 9% of the 257 million were diagnosed and just 1.7 million were on treatment.
- For HCV, 20% of the 71 million had been diagnosed and 1.1 million had started treatment.
Despite those numbers, there are some bright spots, and the WHO is “cautiously optimistic” that its goal of eliminating viral hepatitis as a public health issue by 2030 is possible, according to Yvan Hutin, MD, PhD, also of the WHO hepatitis program.
Hutin presented the report, to enthusiastic applause, at a packed general session here.
The report “is a hugely important document,” commented Tom Hemming Karlsen, MD, PhD, of Oslo’s University Hospital Rikshospitalet, who co-moderated the general session as well as a media briefing later.
“These are really the best data that we have and they give us an idea of the size of the problem,” Karlsen said.
As well, he added, the report forms a baseline that will allow health officials to measure the impact of interventions.
While there are several forms of viral hepatitis, the WHO concentrated on HBV and HCV because they are associated with the most damage to public health. But the pictures drawn by the data show vastly different patterns.
For instance, HBV is relatively rare in the Americas and highly prevalent in the Western Pacific Region and Africa, which have some 68% of all cases. There is no curative treatment, although there are medications that halt viral replication, and there is a highly effective vaccine.
That last fact is one of the bright spots, Hutin noted. Since the three-dose childhood HBV vaccine was introduced in the early 1980s, vaccine use has grown to the point that global coverage is currently 84%.
That has led to a sharp decline in the rate of chronic HBV infection in children under 5 — from 4.7% in the pre-vaccine era to 1.3% in 2015. On the other hand, coverage with the so-called birth dose, aimed at preventing mother-to-child transmission, lags behind at 39%.
In contrast, the burden of HCV is relatively even across WHO regions, there is no vaccine, but — another bright spot — there are novel agents that are almost universally curative.
Hirnschall said the WHO sees nine main topics in two categories — prevention and care and treatment — that need to be addressed to eliminate viral hepatitis.
Prevention, he said, is in pretty good shape: vaccine coverage for HBV is approaching the WHO goal of 90% of children immunized; the vaccine birth dose is being more and more widely used; about 80% of blood supplies are safe; and the re-use of medical injection equipment is uncommon.
The care and treatment part of the picture is less good, he said. Harm reduction efforts, as well as diagnosis and treatment of the two viruses, are reaching no more than 20% of the target populations, while the goals call for rates between 80% and 100%.