WHO Reports Global Burden of Viral Hepatitis Is Increasing

The World Health Organization (WHO) just published the very first Global Hepatitis Report, which supports WHO’s goal of significantly reducing the number of new viral hepatitis cases and related deaths by 2030.

In May of last year, WHO “endorsed the Global Health Sector Strategy (GHSS) on viral hepatitis 2016-2021,” which aims to reduce new cases by 90% and mortality rates by 65%. Recently, a modeling study from the Center for Disease Analysis observed that WHO had not yet set “the exact measures that need to be taken to achieve” the GHSS goal.

Today, April 21, 2017, WHO released a report that outlines the 2015 global burden of hepatitis B (HBV) and C (HCV), the leading causes of all hepatitis-related deaths. According to WHO, the report “presents data along the five strategic directions (strategic information, interventions, equity, financing, and innovation) — [which are the] key pillars of the GHSS to facilitate monitoring of progress in countries, regions, and globally, and to measure the impact of interventions on reducing new infections and saving lives between 2015 and 2030.”

According to the report, in 2015 alone, 325 million people (4.4% of the world’s population according to the World Hepatitis Alliance) were living with viral hepatitis. HBV infections accounted for 257 million (3.5%) of these cases. In that same year, HBV and HCV were the cause of 1.34 million deaths worldwide, a large number of which were due to chronic liver disease and hepatocellular carcinoma. This number far exceeds the number of deaths worldwide related to HIV and tuberculosis (TB) in 2015. Furthermore, although the number of HIV- and TB-related deaths seems to be on a downward trend, “the number of deaths due to viral hepatitis is increasing over time.” The report notes that those areas with the highest burden of HBV are the WHO African Region and the Western Pacific Region, with the highest HCV burden lying in the WHO Eastern Mediterranean Region, and the European Region. In addition, HCV burden “affects all regions, with major differences between and within countries.”

In 2015, 84% of infants worldwide received the HBV vaccine. As a result, HBV infection among children has dropped to 1.3%. In contrast, the global burden of HCV infections increased in 2015. The report notes, “Globally, 5% of healthcare-related injections remained unsafe [in 2015],” which led to millions of new HCV infections in that year.

As a matter of fact, “Each year, 1.75 million people newly acquire hepatitis C virus infection… The world has only recently expressed its alarm about the burden of viral hepatitis,” WHO Director General Margaret Chan, MD, MPH, wrote in the report’s Foreword.

Testing for hepatitis is not always affordable, which results in many undiagnosed carriers. In 2015, of those who carry HBV, only 9% (22 million individuals) were diagnosed, and for HCV that number was 20% (14 million individuals). Additionally, only 1.7 million of those diagnosed with HBV had started treatment, while 1.1 million of those diagnosed with HCV had started treatment. “While the cumulative number of persons treated for HCV reached 5.5 million in 2015, only about half a million of these persons had received the newer, more effective and better tolerated class of drugs called direct-acting antivirals (DAAs),” the report stated. “There were more new HCV infections than patients who were started on treatment in 2015.”

Nonetheless, several countries have started offering more affordable testing and treatment options to infected residents. HCV and HBV can now be diagnosed for $0.50 in some countries. These countries also offer tenofovir, which the report dubs “the most effective hepatitis B treatment,” for $48 a year, and a full regimen of DAAs for the treatment of HCV for $200.

The report also highlights the need for “immediate action” to “expand treatment for people living with HIV who are coinfected with HBV or HCV,” because “liver diseases are a major cause of morbidity and mortality” among this population. In fact, in 2015, 2.7 million of those living with HIV (36.7 million individuals) had chronic HBV infection, and 2.3 million had HCV.

To get on track for eliminating viral hepatitis globally, countries and global partners can follow five steps set forth by the report:

1. A strategic information system based on surveillance and programme data is needed to direct policy change and implementation.
2. Service coverage of testing and treatment needs to be rapidly scaled up.
3. Hepatitis services need to be delivered through a public health approach to benefit all.
4. Sustainable financing is required to enable universal health coverage, the overarching framework for health in the 2030 Agenda for Sustainable Development.
5. Innovations are necessary; new diagnostics, treatments, cure and vaccines need to be developed, tested and delivered urgently to transform the hepatitis response and attain the elimination targets.

Director General Dr. Chan concluded in her statement, “I urge all countries to seize the opportunities set out in this report to eliminate viral hepatitis as a public health threat by 2030. Doing so will free the world from what we know is a leading killer worldwide.”

To read the full WHO Global Hepatitis Report, click here.