Government - Introduction
Viral hepatitis is a group of infectious diseases that aff ects hundreds of millions of people worldwide. Five distinct hepatitis viruses have been identifi ed: A, B, C, D and E. Hepatitis B and C, which can lead to chronic hepatitis, are particularly prevalent; 240 million people are thought to be chronically infected with hepatitis B and 184 million people have antibodies to hepatitis C. 1,2
The fi ve hepatitis viruses have diff erent epidemiological profi les and also vary in terms of their impact and duration. The transmission route depends on the type of virus. Transmission routes that contribute greatly to the spread of hepatitis are exposure to infected blood via blood transfusion or unsafe injection practices, consumption of contaminated food and drinking water, and transmission from mother to child during pregnancy and delivery. Unsafe injection practices, including the use of unsterile needles and syringes, serve as a major pathway for the spread of hepatitis B and C, and reducing transmission of both diseases means changing these practices.
Due to its largely asymptomatic nature, viral hepatitis is a silent epidemic; most people are unaware of their infection. Untreated chronic hepatitis B and C infection can result in liver cirrhosis and liver cancer. According to the Global Burden of Disease estimates, hepatitis B and hepatitis C together caused 1.4 million deaths in 2010, including deaths from acute infection, liver cancer and cirrhosis.3 To put these fi gures in the context of other major infectious diseases, it is estimated that malaria caused 660 000 deaths in 2010,4 and tuberculosis and HIV 1.4 and 1.7 million deaths, respectively, in 2011.5,6 Prevention and control of hepatitis can therefore make a signifi cant contribution to saving lives by preventing cancer and thereby reducing the burden of noncommunicable diseases.
The global public health response to viral hepatitis recognizes that surveillance and control are vital to ensure that testing, care and treatment are available to all people who need these services in every country of the world. As there is an eff ective vaccine for hepatitis B, immunization has been a central strategy for most countries to reduce the burden of hepatitis B. There is no vaccine available to prevent the spread of hepatitis C, but the screening of blood products and the use of sterile needles and syringes have contributed to lowering hepatitis C transmission in many countries.
However, as with other major public health challenges, the mere existence of eff ective tools and strategies for prevention and treatment is not enough to halt viral hepatitis. A major stumbling block has been the low awareness of viral hepatitis, both in the general population and among key populations. Since knowledge about the various risks and transmission routes is central to preventing the spread of hepatitis, increasing awareness is an important component of the global public health response.
Increasing awareness is also key to making hepatitis a larger part of the local, national and regional health agenda. Gaps can be seen between policy and practice, as even in countries with evidence-informed hepatitis policies, there is inadequate implementation of protocols for prevention, treatment and control. This situation indicates a need for improvement in the response to viral hepatitis at all levels.
A global problem with a global response
Viral hepatitis is a global health problem from which no country, rich or poor, is spared. This problem takes a multitude of diff erent forms, with factors such as the type of hepatitis, the most common transmission pathways, and the most eff ective strategies for diagnosis and treatment all varying across and within countries. Thus, global eff orts to make hepatitis a public health priority need to be transformed into prevention and control strategies that are tailored to specifi c conditions at the national and sub-national levels.
In 2010, the World Health Assembly adopted resolution WHA 63.18 in recognition of viral hepatitis as a global public health problem.7 The resolution emphasized the need for governments and populations to take action to prevent, diagnose and treat viral hepatitis, and called upon the World Health Organization (WHO) to develop and implement a comprehensive global strategy to support these eff orts. WHO has crafted guidance for the World Health Assembly’s 194 Member States within a health systems approach, as described in Prevention and control of viral hepatitis infection: framework for global action.1 The WHO strategy addresses the following axes:
- Awareness-raising, Partnerships and Resource Mobilization
- Evidence-based Policy and Data for Action
- Prevention of Transmission
- Screening, Care and Treatment.
The 2010 resolution adopted by the World Health Assembly furthermore designated 28 July as World Hepatitis Day, envisioning this as an opportunity for Member States to promote awareness about viral hepatitis.7 The fi rst offi cial World Hepatitis Day was in 2011. WHO encourages governments, international organizations and civil society groups around the world to observe World Hepatitis Day with activities that call attention to the disease burden imposed by viral hepatitis, and to the prevention and control measures that need to be implemented.
Monitoring the response: the 2012 survey
The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey of how all Member States are responding to viral hepatitis. In mid-2012, WHO and the World Hepatitis Alliance conducted such a survey, asking Member States to provide information relating to the four axes of the WHO strategy.
This report presents the survey results. It describes the major dimensions of prevention and control policies and programmes for viral hepatitis in WHO Member States. Furthermore, survey data provide insight into how conditions in specifi c countries may have hindered previous eff orts to achieve hepatitis policy objectives. Findings also highlight gaps that must be addressed in order to improve hepatitis policies and programmes at the national and global levels.
The second chapter of this report provides an overview of the global fi ndings. Chapters three through eight present fi ndings from the six WHO regions, including summaries of data from all responding countries. Additional data for selected survey questions appear in Annexes A–C. Annex D describes the study methodology, and Annex E the survey instrument.
It is anticipated that follow-up surveys, some utilizing the same questionnaire and others addressing specifi c issues in greater detail, will be carried out every one to two years to monitor overall progress in implementation of the WHO hepatitis prevention and control strategy.
- Prevention and control of viral hepatitis infection: framework for global action. Geneva, WHO, 2012.
- Mohd Hanafi ah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specifi c antibody to HCV seroprevalence. Hepatology, 2013, 57(4):1333–1342.
- Lozano R et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2095–2128.
- World malaria report 2012. Geneva, WHO, 2012. Available at: http://www.who.int/malaria/publications/world_malaria_report_2012/wmr2012_no_profi les.pdf (accessed on 03 May 2013).
- Global tuberculosis report 2012. Geneva, WHO, 2012. Available at: http://www.who.int/tb/publications/global_report/gtbr12_main.pdf (accessed on 03 May 2013).
- UNAIDS Report on the global AIDS epidemic 2012. Geneva, 2012. Available at: http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp (accessed on 03 May 2013).
- World Health Organization. Sixty-third World Health Assembly. Viral hepatitis: WHA 63.18. Geneva, Switzerland, 21 May 2010.