Global Efforts Needed Against Hepatitis

World Health Organization reports lack of uptake of hepatitis treatments.

New findings from the World Health Organization (WHO) suggest that more than 325 million people have hepatitis B virus (HBV) or hepatitis C virus (HCV) worldwide.

The WHO Global hepatitis report, 2017 has found that a majority of these individuals do not have access to treatment, which results in chronic liver disease, cancer, and death.

The authors discovered that hepatitis caused 1.34 million deaths in 2015, and continues to increase. During this time, an additional 1.75 million individuals developed an HCV infection, bringing the global total to 71 million, according to WHO.

While deaths from hepatitis have been on the upward trend, new incidences of HBV are decreasing, as the result of an uptake of the HBV vaccine among children. According to the study, 84% of children born in 2015 received the 3-dose HBV vaccine to prevent the infection.

From the pre-vaccination era (1980s to early 2000s) to 2015, the authors discovered that children under age 5 who developed HBV decreased from 4.7% to 1.3%, respectively. This suggests that the vaccine can effectively prevent the infection among children. Despite these gains, 257 million individuals were living with HBV in 2015, according to the study.

The report indicated an HBV disease burden among African and Western Pacific Regions, which had 115 million and 60 million cases of the infection in 2015, according to the study. In 2015, there were 21 million people with HBV living in the Eastern Mediterranean Region and 39 million in South-East Asia Region.

The lowest burden was found in the European Region and the Region of the Americans, which had 15 million and 7 million individuals with HBV during this time period.

The WHO reports that unsafe injections in hospitals and injection drug use have been the main drivers of HCV transmission. The Eastern Mediterranean Region was found to have 15 million individuals infected with HCV, while the Region of the Americans only had 7 million cases in 2015, likely due to increased access to curative treatments.

Despite approvals of curative drugs for HCV and HBV, access to the treatment remains low. Additionally, the lack of a HCV vaccine has led to potentially preventable cases of the infection, according to WHO.

While 9% of all HBV infections and 20% of all HCV infections were diagnosed in 2015, only 8% and 7% of patients diagnosed, respectively, received treatment that year.

"We are still at an early stage of the viral hepatitis response, but the way forward looks promising," said Gottfried Hirnschall, MD, director of WHO's Department of HIV and the Global Hepatitis Programme. "More countries are making hepatitis services available for people in need — a diagnostic test costs less than US $1 and the cure for hepatitis C can be below US $200. But the data clearly highlight the urgency with which we must address the remaining gaps in testing and treatment."

However, some countries have been taking steps to bolster the fight against hepatitis. The WHO found that 96% of children born in China in 2015 received a timely dose of the HBV vaccines and achieved less than 1% of infections among children.

Additionally, Mongolia implanted a national insurance program, which covers nearly all of its population and grants access to HBV and HCV drugs. Increased generic competition in Egypt has reduced a HCV cure from $900 in 2015 to less than $200 to date, according to WHO.

"Viral hepatitis is now recognized as a major public health challenge that requires an urgent response," said Margaret Chan, MD, WHO director-general. "Vaccines and medicines to tackle hepatitis exist, and WHO is committed to helping ensure these tools reach all those who need them."