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WHO urges government action against hepatitis
WHO has released a global policy report on the prevention and control of hepatitis in member states.
The report contains information from a survey of 126 countries — the first of its kind. It identifies successes and gaps in the implementation of WHO’s four priority areas for hepatitis: raising awareness, evidence-based data for action, prevention of transmission, and screening, care and treatment.
According to survey findings, only 37% of the 126 countries have national strategies for viral hepatitis. In addition, most of the countries (82%) have hepatitis surveillance programs, but only half of them include monitoring for chronic hepatitis B and C, which are responsible for most severe illness and death.
“Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in the future,” Sylvie Briand, MD, MPH, PhD, director of Pandemic and Epidemic Diseases at WHO, said in a press release. “The findings underline the important work that is being done by governments to halt hepatitis through the implementation of WHO recommended policies and actions.”
WHO has collaborated with countries and partners since the World Health Assembly acknowledged the challenges related to hepatitis in 2010 and adopted a resolution that called for prevention and control of the disease. According to the report, 38% of countries observe World Hepatitis Day, which was established in 2010, and more are expected to participate this year.
Other key findings outlined in the report include:
- As of 2011, 180 countries included hepatitis B vaccination in their routine vaccination schedules, and the coverage is nearly 80%;
- Nearly two-thirds of member states have a vaccination policy for health care workers, but transmission of hepatitis to patients via unsafe injection problems is still a problem;
- 94.4% of member states screen donated blood for hepatitis B and 91.3% screen for hepatitis C; and
- Only half of member states have clinical guidelines for hepatitis treatment, but about 60% have publicly funded treatment programs.
WHO is currently developing screening, care and treatment guidelines for hepatitis C.
“New, more effective medicines to prevent the progression of chronic hepatitis B and C are in the pipeline,” Stefan Wiktor, MD, team leader of WHO’s Global Hepatitis Program, said in a press release. “However, these will be expensive and therapy will require monitoring with sophisticated laboratory tests. To cure and reduce the spread of these viruses, medicines must become more accessible.”
For more information:
WHO. Global policy report on the prevention and control of viral hepatitis in WHO member states. Available at: http://www.who.int/csr/disease/hepatitis/global_report/en/index.html.
Perspective
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I’ve been in the hepatology field for 40 years, and viral hepatitis — mainly hepatitis C but also hepatitis B — continues to be a leading cause of cirrhosis, end-stage liver disease, need for liver transplant and death. Viral hepatitis is a very significant health care problem in the United States, and an even a bigger problem in other parts of the world. When I began my career, there was no treatment and there were no preventive measures, apart from good sanitation, that would lend themselves to any hope for reducing prevalence of these diseases. Now we have a large number of tools at our disposal. We can totally prevent hepatitis A and hepatitis B through immunization. We also understand how these diseases are transmitted, which gives us powerful tools to reduce transmission of hepatitis B and C from one individual to another. The treatment for hepatitis C was nonexistent 25 years ago; now, combinations of medications can cure up to 90% of cases, with improvements continuing to come on line. Enormous strides have been taken to allow for decreased transmission of hepatitis C. Blood transfusions used to be a very common mode, but most countries now screen the blood supply for these diseases, reducing transmission significantly. Since hepatitis C is a “stealth” disease, causing few or no symptoms in most, it is vital that widespread screening take place to identify those who are infected, so that appropriate treatment can be offered.
Antiviral therapy for hepatitis B is much simpler than that for hepatitis C. Although years of treatment are usually necessary, the pills used for hepatitis B have very few side effects. However, hepatitis B remains one of the most frequent chronic infections in the world, and one of the leading causes of liver cancer. In many countries, it is transmitted from mother to child, but neither becomes sick until they have liver cancer or cirrhosis. Every pregnant woman needs to be tested for hepatitis B to prevent transmission to baby. It can be almost completely prevented by immunization. The resources and the will to immunize the public is an extremely effective means of interruption of hepatitis B. Compliance with that varies from one jurisdiction to another. Since immunization was instituted in Taiwan about 20 years ago, the incidence of mother-to-child transmission of hepatitis B has almost vanished, and the incidence of hepatitis B is extremely low, where it used to be very high. The same thing is happening in mainland China, now that they’ve begun to immunize. Every country ought to have a public health policy that directs immunization against hepatitis B. It’s highly effective, low cost, and no toxicity. Wherever this disease continues to exist, it’s a failure of public health.