July 07, 2016

Despite vaccines for hep A and B and treatments for C global deaths from hepatitis was 1.45 million in 2014

Viral hepatitis is one of the leading killers across the globe, with a death toll that matches Aids or tuberculosis, research in the Lancet suggests.

The report estimates that hepatitis infections and their complications led to 1.45 million deaths in 2013 - despite the existence of vaccines and treatments.

World Health Organization data shows there were 1.2 million Aids-related deaths in 2014, while TB led to 1.5 million deaths.
The WHO has put forward a global strategy to tackle hepatitis.

The WHO hepatitis strategy, which was put forward in May 2016, includes targets to reduce new cases of hepatitis B and C by 30% by 2020, alongside a 10% reduction in mortality.

The WHO says countries and organisations will need to expand vaccination programmes, focus on preventing mother-to-child transmission of hepatitis B and increase access to treatment for hepatitis B and C, to help ensure these targets are met.

Viral hepatitis refers to five different forms of virus (known as A, B, C, D, E) - some can be spread through contact with infected bodily fluids and others (A and E) through contaminated food or water.

Most deaths worldwide are due to B and C, which can cause serious liver damage and predispose people to liver cancer. But because people don't always feel the symptoms of the initial infection, they can be unaware of the long-term damage until it is too late.

WHO global health sector strategy on viral hepatitis 2016-2021

Dr Graham Cooke of Imperial College London described the findings as startling.

He said: "Although there are effective treatments and vaccines for viral hepatitis, there is very little money invested in getting these to patients - especially compared to malaria, HIV/AIDS and TB.

"We have tools at our disposal to treat this disease - we have vaccines to treat hepatitis A and B and we have new treatments for C.

"However the price of new medicines is beyond the reach of any country - rich or poor."

The study suggests the problem is biggest in East Asia.

But unlike many other diseases, deaths from viral hepatitis were higher in high and middle income countries than in lower income nations.

Ending hepatitis epidemics as a major public health threat is feasible with the tools and approaches currently available and in the pipeline.

Opportunities exist for enhancing and expanding the response by investing in five core intervention areas:

  1. Vaccines – Effective vaccines are available for preventing viral hepatitis A, B and E infections, with a range of countries already implementing large-scale and inexpensive hepatitis B virus childhood vaccination programmes;
  2. Prevention of mother-to-child transmission of hepatitis B virus – Timely hepatitis B virus birth-dose vaccination is a key intervention for preventing the transmission of the virus from mother to infant at birth, which could be enhanced through antenatal testing and the use of antiviral drugs;
  3. Injection, blood and surgical safety – transmission of viral hepatitis B and C in health care settings can be stopped through the rigorous application of universal precautions for all invasive medical interventions, promotion of injection safety measures and securing the safe supply of blood products;
  4. Harm reduction for people who inject drugs – Ensuring access to sterile injecting equipment and effective drug dependence treatment can prevent and control epidemics of viral hepatitis B and C among people who inject drugs, as part of a comprehensive package of interventions for the prevention, treatment and care of HIV, viral hepatitis and other blood-borne infections among people who inject drugs;
  5. Treatment – New oral, well-tolerated medicines and treatment regimens for people with chronic hepatitis C virus infection can achieve cure rates of over 90%. Effective treatment is also available for people with chronic hepatitis B virus infection, although for most people such treatment needs to be lifelong.

To have greatest impact, effective interventions should be combined and tailored for the specific population, location and setting. For example, for hepatitis B virus epidemics, in certain countries with high prevalence of this virus, the most significant public health benefits are likely to be achieved by focusing efforts on reducing deaths by the prevention of early-life infection through birth-dose and childhood vaccination, and the treatment of people with chronic hepatitis infection

Simple and effective hepatitis testing strategies and tools are lacking, with less than 5% of people with chronic hepatitis infection knowing their status. For this reason, diagnosis often occurs late and appropriate tests to assess liver disease and guide treatment decisions, including when to start treatment, are seldom available.

Birth-dose vaccination is a key intervention for prevention of hepatitis B virus infection in infants. However, its delivery can be a challenge in communities where a large proportion of births occur outside of health facilities. As a result, global coverage is only around 38%. This strategy calls for the expansion of interventions to prevent mother-to-child transmission of hepatitis B virus to achieve a coverage of 50% by 2020 and 90% by 2030.

New study findings published today confirm that antiviral therapy with tenofovir in late pregnancy can result in a 3-fold reduction in mother-to-child transmission (MTCT) of hepatitis B virus (HBV), when used in combination with immunoglobulin and HBV vaccine at birth.

WHO currently recommends that all newborns be given timely HBV vaccine at birth, followed by 2 or 3 additional doses. Birth dose vaccination prevents HBV transmission to the infant in most cases, but some women with high levels of HBV may still transmit infection to their children.

The WHO Western Pacific Region, which includes China where the study took place, has particularly high rates of HBV infection. With only a quarter of the world's population, the region bears 40% of global deaths from viral hepatitis, with more than 1500 lives lost each day due to hepatitis.

This recent randomized controlled trial enrolled 200 women with high viral load of HBV living at 5 sites in 5 geographic regions in China, between March 2012 and June 2013. They were in late pregnancy and were provided tenofovir therapy starting from 30 to 32 weeks of gestation until 4 weeks after the birth.All delivered infants in the study were given immunoglobulin and birth dose HBV vaccine, followed by two additional HBV vaccinations.

The study resulted in a 3-fold reduction in transmission for highly infectious pregnant mothers from 18% to 5%.

China is home to about 90 million people living with Hepatitis B, the largest number in any country worldwide. Approximately 6% of women giving birth are living with HBV. “China has achieved extraordinary success in increasing hepatitis B vaccine coverage among newborns over the last two decades," said Dr Bernhard Schwartländer, WHO Representative in China. "The findings of this study show that adding cutting edge treatment for Hepatitis B of pregnant women to the package of interventions available today, will not only have health benefits for mothers, it will help China another step closer to the goal of a hepatitis-free generation".

The HBV infection rates in China dropped from 9.75% in the general population, including children aged 1–4 years, in 1992 to as little as 0.32% in children under the age of 5 in 2014. But with an estimated 15 million births occurring annually, 50 000 children are born with HBV every year, despite vaccination efforts.

SOURCES- BBC News, World Health Organization

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