World Hepatitis Day: making hepatitis elimination a reality
The world is poised to eliminate viral hepatitis as a public health threat by 2030. This will mean achieving a 90% reduction in new infections and a 65% reduction in deaths in the period leading up to 2030.
More than 400 people die from causes related to viral hepatitis every day in the WHO European Region, and the numbers are rising. It is estimated that more than 15 million people are chronically infected with hepatitis B virus and another 14 million people with hepatitis C virus. Approximately two thirds of chronic hepatitis infections in the Region occur in eastern Europe and central Asia.
The campaign for this year’s World Hepatitis Day, held annually on 28 July, is “Eliminate hepatitis”. It commemorates global, regional and country efforts to combat viral hepatitis and provides a powerful opportunity to increase public awareness of the devastating disease, advocating improved access to and availability of testing, treatment and preventive measures.
Hepatitis B virus (HBV)
A vaccine is 95% effective in preventing HBV infection and its chronic consequences, which include liver cancer. Universal HBV vaccination programmes for infants, with the first dose at birth, have been highly effective in reducing the number of infections, but much more needs to be done.
It is vital that routine coverage of hepatitis B vaccination be scaled up. In 2017, 48 of the 53 countries in the WHO European Region conducted universal HBV vaccination, but only 26 vaccinated all newborns; the other 22 started vaccination at the age of 2 months or later.
Hepatitis C virus (HCV)
HCV infection can be transmitted in three ways:
- during injecting drug use, through the sharing of injection equipment;
- in health care settings as a result of reuse or inadequate sterilization of medical equipment, especially syringes and needles; and
- in some countries, via transfusion of unscreened blood and blood products.
New antiviral medicines can cure more than 95% of people with HCV infection, greatly reducing the risk of complications and death. Without treatment, the risk of developing cirrhosis of the liver among people with chronic HCV infection is 15–30% within 20 years.
At present, no vaccine against HCV is available, and prevention of the infection depends on reducing exposure to the virus in health care settings and in high-risk populations, such as people who inject drugs. Effective preventive measures include screening, testing of blood and organ donors, good infection control and harm reduction – including needle and syringe exchange programmes – and ensuring safe injection practices in health care settings.
National strategy guides elimination efforts: Georgia
For countries to make real and sustainable progress towards eliminating viral hepatitis, they must develop comprehensive national strategies. Georgia, a country with a high number of HCV infections, offers an example of how a strong national plan can guide a country towards elimination.
In April 2015, Georgia became the first country in the WHO European Region to endorse a national HCV programme and approve a long-term elimination strategy. The strategy has helped to drive improvements in monitoring and surveillance, overall infection control and prevention; it has also expanded the delivery of hepatitis C screening, diagnosis and treatment services.
To mark World Hepatitis Day, the WHO Regional Office for Europe, in collaboration with the Ministry of Labour, Health and Social Affairs of Georgia, is hosting a meeting in Tbilisi to review and share lessons learnt from the Georgian hepatitis C elimination programme.
Prevention as an essential part of elimination: Norway and the United Kingdom
Eliminating the threat of HBV infection requires a comprehensive approach that includes prevention of infections acquired immediately before and after birth and during childhood, as well as during adolescence and adulthood.
Norway and the United Kingdom have recently become the latest countries in the WHO European Region to add hepatitis B vaccination to their routine immunization schedules: Norway has offered the vaccine since February 2017 and the United Kingdom will provide a hexavalent vaccine, including hepatitis B, at age 2 months for children born after 1 August 2017. With these two additional countries offering population-wide protection against the virus, the Region is one step closer to its goal of controlling HBV infection, as established in the European Vaccine Action Plan 2015–2020. Follow the link below to read more about hepatitis B vaccination in the Region.
Expanding access to treatment: Republic of Moldova
While new antiviral medicines can cure most people infected with hepatitis C, they are often prohibitively expensive. The Republic of Moldova is one country that has made great progress in improving access to these medicines. In 2016, WHO updated its hepatitis C treatment and care guidelines, which strongly recommend direct-acting antivirals. Following this update, the Centre for Centralized Procurements in Health in the Republic of Moldova worked with WHO to identify ways to make medicines to treat hepatitis C more affordable, resulting in a procurement procedure for the introduction of generics.
Prior to the introduction of this procedure, around 7000 people were registered and waiting for treatment, and approximately 300–400 people were being treated every year. Since 2016, 3000 people have already been treated with the new direct-acting antivirals and a second wave will soon begin treatment. Learn more about efforts to improve access to hepatitis C treatment in the Republic of Moldova by watching the video to the right.
Countries across the WHO European Region, from Georgia to the United Kingdom, are taking steps to bring closer the reality of achieving the elimination of viral hepatitis.