World Hepatitis Day 2017: Eliminate
The World Hepatitis Day on 28 July 2017 is an opportunity to add momentum to all efforts to implement the WHO’s first global health sector strategy on viral hepatitis for 2016-2021 and help Member States achieve the final goal – to eliminate
Activities and awareness around World Hepatitis Day are designed to:
- Build and leverage political engagement following official endorsement of the Global Health Sector Strategy on viral hepatitis at the World Health Assembly 2016.
- Showcase emerging national responses to hepatitis in heavy burden countries.
- Encourage actions and engagement by individuals, partners and the public.
- Highlight the need for a greater global response as outlined in the WHO’s Global hepatitis report of 2017.
In support of the “Eliminate hepatitis” campaign, WHO will release new information on national responses in 28 countries with the heaviest burden.
11 countries which carry almost 50% of the global burden of chronic hepatitis:
Brazil, China, Egypt, India, Indonesia, Mongolia, Myanmar, Nigeria, Pakistan, Uganda, Viet Nam.
17 countries that also have high prevalence and together with the above, account for 70% of the global burden:
Cambodia, Cameroon, Colombia, Ethiopia, Georgia, Kyrgyzstan, Morocco, Nepal, Peru, Philippines, Sierra Leone, South Africa, Tanzania, Thailand, Ukraine, Uzbekistan, Zimbabwe.
What is hepatitis?
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
What are the different hepatitis viruses?
Scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.
Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.
Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.
Q&A WHO (http://www.who.int/features/qa/76/en/)
Key messages for World Hepatitis Day 2017
1. Viral hepatitis is a major global health problem and needs an urgent response.
There were approximately 325 million people living with chronic hepatitis at the end of 2015. Globally, an estimated 257 million people were living with hepatitis B (HBV) infection, and 71 million people were living with hepatitis C (HCV) infection in 2015.
2. Very few of those infected accessed testing and treatment, especially in low- and middle-income countries.
By the end of 2015, only 9% of HBV-infected people and 20% of HCV-infected people had been tested and diagnosed. Of those diagnosed with HBV infection, 8% (or 1.7 million people) were on treatment, while 7% of those diagnosed with HCV infection (or 1.1 million people) had started treatment in 2015.
The global targets for 2030 are: 90% of people with HBV and HCV infections tested and 80% of eligible patients are reached with treatment.
3. Viral hepatitis caused 1.34 million deaths in 2015 – comparable with TB deaths and exceeding deaths from HIV. Hepatitis deaths are increasing.
4. New hepatitis infections continue to occur, mostly hepatitis C.
The number of children under five living with chronic HBV infection was reduced to 1.3% in 2015 (from 4.7% before vaccines were introduced).
Hepatitis B vaccine is preventing approximately 4.5 million infections per year in children.
However, 1.75 million adults were newly infected with HCV in 2015, largely due to injecting drug use and due to unsafe injections in health care settings in certain countries.
5. Achieving the 2030 elimination goal is not overly ambitious; reports from 28 high-burden countries give cause for optimism.