The liver processes nutrients, helps to fight against infection, and aids in cleaning the blood in our bodies. Inflammation of the liver is generally known as hepatitis. Although hepatitis can be caused by autoimmune disorders, occur as a result of excessive alcohol consumption, or become induced after a toxin is introduced into the liver, the hepatitis of most concern has a viral origin. While there are 5 main viruses (Hepatitis A-E), Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) are responsible for the majority of morbidity and mortality cases associated with viral hepatitis infections globally- this is comparable to HIV/AIDS and TB, killing 1.34 million people a year. Hepatitis can either be acute (i.e. a short-term illness within 6 months of infection) or chronic. 75-80% of individuals infected with HCV will develop a chronic infection. The likelihood of HBV becoming chronic largely depends on the age at which infection occurs. According to the Centers for Disease Control and Prevention (CDC), 90% of infants, 25-50% of children between 1-5 years of age, and 6-10% of individuals over 5 years of age will develop chronic HBV. Although the majority of individuals are diagnosed at a young age, younger age groups are less likely to show symptoms.
Risk factors for HBV and HCV include:
- Being exposed to contaminated needles (i.e. with infected blood) during intravenous drug use or within a medical setting; in the case of HBV, having sex with an infected person or sharing hygienic items such a razors or toothbrushes are risk factors as well. An infected mother can also vertically transmit the infection to her baby.
- Unsafe blood transplants or transfusions (i.e. infected blood being donated to otherwise healthy individuals); in the case of HCV, risk would mostly be associated with transplants or transfusions received before 1992.
According to the World Health Organization (WHO), there are differences in global burden of disease trends for HCV and HBV:
- HCV: Affects all regions although there are significant differences between and within countries. The WHO Eastern Mediterranean Region and the European Region have the highest reported prevalence of HCV.
- HBV: Mostly affects the WHO African Region and the Western Pacific Region
The number of cases of hepatitis that are diagnosed increases every year as well as deaths, which have increased by 50% over the past 20 years. Even worse, most people with hepatitis are asymptomatic in the acute stage and the beginning of the chronic stage- those with symptoms may have fever, jaundice, loss of appetite, grey stools, dark urine, and abdominal pain. Although a vaccine is only available to protect against HBV, effective treatment options exist for both chronic HBV and HCV. This is an important reality since therapy and proper case management can reduce the risk of complications such as cirrhosis, liver cancer, and premature death that are caused by chronic hepatitis infection. Access strategies supported by the WHO in 13 countries have helped more middle-income countries receive necessary medications such as Directing Acting Antirals (DAA). These drugs have a cure rate of over 95% within a 3-month timeframe, for HCV, and less side effects than other drugs- but 80% of HCV cases still have difficulties accessing the treatment and case management they need because it can be expensive. The WHO released the report, “Global Report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers,” which discussed the importance of political mobilization, advocacy, and pricing negotiations on increasing access to necessary medications in low-middle income countries. Local, more cost-effective medications have even been manufactured in a few countries. In order to address the 80% of people still in need of help, in May 2016, at the World Health Assembly, 194 countries adopted the Global Health Sector Strategy on Viral Hepatitis with the goal of eliminating hepatitis by 2030. DAAs were also added to the List of Essential Medicines.
Information from the global strategy is incorporated into World Hepatitis Day activities. World Hepatitis Day occurs on July 28th every year and is focused on raising awareness about the global burden of viral hepatitis as well as the prevention and treatment options that exist. Watch these short videos to learn more about the WHO’s global strategy and the theme for this year!