Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main strains of hepatitis viruses that cause acute and/or chronic infection, referred to as types A, B, C, D and E. People who are infected with any of the virus strains can experience mild illness or serious and permanent liver damage. In particular, types B and C lead to chronic disease in hundreds of millions of people worldwide and, together, are the most common cause of liver cirrhosis and cancer.
Viral hepatitis is a largely neglected epidemic in the WHO European Region. An estimated 13 million people live with chronic hepatitis B, and an estimated 15 million people are infected with hepatitis C, but most are unaware that they are infected due to the virus presenting asymptomatically in 80% of cases. Because the disease is often left untreated, chronic hepatitis is a major cause of liver cirrhosis and primary liver cancer. Hepatitis B is responsible for about 36 000 deaths per year in the Region, whereas hepatitis C causes roughly 86 000 deaths annually.
People who inject drugs (PWID) are particularly vulnerable to hepatitis and, in some settings, almost all PWID are infected with hepatitis C. As PWID are more vulnerable to HIV infection, co-infection with both HIV and hepatitis is particularly common among this vulnerable population in the Region. Between 70-90% of PWID living with HIV have also been diagnosed with hepatitis C. With increasing availability of effective treatment for HIV, viral hepatitis that is both chronic and untreated is becoming the more predominant cause of death than HIV among people living with HIV/Hepatitis co-infection in the European Region.
As a person with hepatitis may have no symptoms for a long time, the epidemic is largely hidden and until recently, was not fully recognized as a public health problem in the Region. As a result:
- hepatitis surveillance is weak – the number of persons living with different forms of chronic hepatitis are not known accurately;
- the cost of diagnosis and treatment of hepatitis remains high and treatment remains often inaccessible and unaffordable for many of those in need; and
- access to prevention and treatment services is limited in many countries of the Region, particularly in eastern Europe and central Asia.