Study Shows Progress Against Viral Hepatitis, But Vast Majority of Infections Remain Undiagnosed

Global efforts to eliminate hepatitis B and hepatitis C as a public health threat by 2030 have made progress but must be accelerated considerably to meet the goal, a recent study by the World Health Organization found.

The study, published in The Lancet Gastroenterology & Hepatology, included survey data from 200 countries and territories, reporting the landscape for hepatitis B and hepatitis C in 2019.

“There were more than 1 million deaths and 3 million new infections from hepatitis B and C” in 2019, Daniel Low-beer, PhD, of the Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at the World Health Organization and colleagues told Contagion. “There has been notable global progress towards hepatitis elimination since 2016, but 90% of hepatitis B infections and 79% of hepatitis C infections remain undiagnosed. Viral hepatitis remains one of the major challenges in global public health of the 2020s.”

The study included officially validated data provided by 130 countries and data on 70 countries provided by partner agencies, including the Center for Disease Analysis Foundation, Imperial College, University of Bristol, the Institute for Health Metrics and Evaluation, and WHO Immunization, Vaccines and Biologicals department.

The study estimated 295.9 million people were living with chronic HBV infection in 2019, an increase of 39 million from previous estimates in 2017, and 57.8 million with chronic HCV infection, a decrease of 1.3 million.

More complete data may account for much of the increase in HBV infections, while the decrease in HCV infections may be related to improvements in treatment and care, the authors said.

“With a huge cohort of 354 million people infected and relatively low coverage of testing and treatment, hepatitis remains one of the major challenges in global public health,” Low-beer and colleagues said. “This is despite a cure for hepatitis C and effective treatment and a vaccine for hepatitis B.”

More people were aware of their hepatitis infection in 2019 than in the previous research, including 30.4 million, or 10.3%, of those with HBV, up from 9% in 2015, and 21.4% of those living with HCV. But those rates fell below global diagnosis targets of 30% for 2020.

“The public health elimination of viral hepatitis B and C is both feasible and affordable but it requires action now to implement WHOs Global Health Sector Strategy on viral hepatitis, 2022-2030,” Low-beer and colleagues said. “The coming few years will be critical for the scale up of effective prevention, diagnosis, treatment and cure.”

About 22.7% of those diagnosed with HBV received treatment in 2019, compared with 8% in 2015. Still, the high rate of undiagnosed HBV infections (90%) leaves 98% of HBV infections untreated. Treatment of HCV infections increased by 10 times since 2016, driving mortality down for the first time. But 87% of HCV infections have not been treated.

“Treatment access and screening were negatively impacted by COVID-19 related disruptions,” Low-beer and colleagues said.

The African and Eastern Mediterranean regions had high concentrations of overall infections, accounting for 40% and 19% of global hepatitis infections respectively. HBV infections were most prevalent in the African region, where 65% of new infections occurred, while the Eastern Mediterranean region accounted for 31% of new HCV infections.

The study authors called for a new strategy to scale up diagnosis and treatment of viral hepatitis.

“The new WHO Global Health Sector Strategy, 2022-30, needs to be implemented urgently, and improved data validated, updated and used at country level to fill gaps in prevention, diagnosis and treatment,” Low-beer and colleagues said. “This has the potential to save 1 million deaths and 3 million new infections per year.”