Viral hepatitis requires more attention in the WHO European Region

There is a silent epidemic of viral hepatitis types B and C in the WHO European Region, where 13.3 million people are estimated to live with chronic hepatitis B and 15 million people with hepatitis C. Worldwide, hepatitis B and C lead to chronic disease in about 500 million people. Together, they are the most common causes of liver cirrhosis and cancer.

Although a blood test shows when someone has viral hepatitis, most people infected with hepatitis B and C do not know it. Only 1 infected person in 5 is estimated to display acute symptoms. Even among such people, testing often does not occur, since acute symptoms are often mild or confused with influenza-like illness. If left untreated, hepatitis B and C may become chronic, and can lead to disease, cirrhosis and cancer of the liver.

There are five strains of viral hepatitis (types A– E), but types B and C account for the largest burden of disease in the WHO European Region, and thus are the main focus of effort.

While hepatitis A and E typically result from ingestion of contaminated food or water, contact with contaminated blood or body fluids typically causes types B, C and D. Hepatitis B is transmitted mainly by sexual contact, from mother to child and through contaminated blood. Hepatitis C is spread primarily by blood-to-blood contact, and less commonly by sexual contact.

Viral hepatitis: a growing problem

Current worldwide estimates indicate that viral hepatitis causes close to 1 million deaths every year: on par with those caused by HIV/AIDS and exceeding the number caused by tuberculosis and malaria.

Each year, hepatitis B causes an estimated 36 000 deaths and hepatitis C, 86 000 deaths in the WHO European Region. In addition, the prevalence of both hepatitis B and C is considerably higher in some groups, particularly people who inject drugs and men who have sex with men. Two thirds of the people with hepatitis B and C in the Region live in eastern Europe and central Asia.

Owing to the high burden of disease, viral hepatitis deserves more attention in Europe. Zsuzsanna Jakab, WHO Regional Director for Europe, said, “Hepatitis B and C each affects up to 2% of the population in the WHO European Region, and together they kill over 120 000 people every year. We need to take urgent action, in close collaboration with our partners, to address this neglected and silent epidemic.”

Addressing the silent epidemic

A safe and effective vaccine against hepatitis B virus infection has been available for over 20 years. Most countries in the European Region have introduced routine immunization of newborn babies and children: a great achievement that will ultimately lead to generations free of hepatitis B. At present, no vaccine against hepatitis C is available, so current efforts focus on improving prevention, diagnosis and treatment.

Efforts to fight viral hepatitis should focus on raising awareness of the disease and preventing it from spreading further. This means promoting vaccination, and safe sex and safe injecting practices.

While new medications to treat chronic hepatitis B and C are becoming available, the burden of disease remains high. Access to medication and the cost of treatment remain important problems. Ensuring accessible testing facilities and accessible and affordable treatment services should remain a priority.

Burden of hepatitis B and C on health care systems

Since hepatitis B and C infections can lead to a state of chronic infection, they can cause several long-term health issues. They are estimated to cause 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer.

Viral hepatitis not only affects the individual, but also places a heavy burden on the health care system because of the costs of treating liver failure and chronic liver disease. In many countries, viral hepatitis is the leading cause of liver transplants. In addition, chronic viral hepatitis results in productivity losses, and necessitates end-stage treatments that can cost hundreds of thousands of dollars.

WHO response to the epidemic

Recognizing the tremendous burden caused by viral hepatitis, the World Health Assembly adopted resolution WHA63.18 in 2010, calling for a comprehensive approach to prevention and control. WHO then established the Global Hepatitis Programme and increased its efforts to address the largely neglected epidemic. These included 2 publications launched in 2012: “Guidance on prevention of viral hepatitis B and C among people who inject drugs” and “Prevention and control of viral hepatitis infection: framework for global action”.

On World Hepatitis Day, 28 July 2013, WHO will launch the “Global hepatitis policy report”, which evaluates policies in more than 120 countries; 44 out of the 53 Member States of the WHO European Region participated in this initiative.