Hepatitis is a significant global public health problem that affects millions of people worldwide. It is an inflammation of the liver that can be caused by various viruses, known as hepatitis viruses.

There are several types of viral hepatitis, including hepatitis A, B, C, D, and E, each with its own mode of transmission, severity, and impact on public health. Hepatitis B and C, in particular, are responsible for the majority of cases and have become a silent epidemic.

The burden of hepatitis worldwide

Hepatitis is a major global health concern, affecting an estimated 325 million people worldwide.

It is responsible for more than 1.34 million deaths annually, making it a leading cause of death worldwide, surpassing other infectious diseases such as HIV/AIDS, tuberculosis, and malaria. Hepatitis B and C viruses are the most common causes of chronic hepatitis, which can lead to liver cirrhosis and liver cancer if left untreated.

The burden of hepatitis is not evenly distributed across the globe. The majority of cases occur in low- and middle-income countries, where access to prevention, testing, and treatment services is often limited.

Sub-Saharan Africa and parts of Asia carry a disproportionate share of the burden.

The hepatitis viruses

There are five different types of viral hepatitis: hepatitis A, B, C, D, and E. Each type has its own distinct characteristics, modes of transmission, and implications for public health.

Hepatitis A

Hepatitis A is usually transmitted through ingestion of contaminated food or water. It causes acute, self-limiting hepatitis, meaning it does not lead to chronic infection.

Hepatitis A can be prevented through improved sanitation, access to clean water, and vaccination.

Hepatitis B

Hepatitis B is transmitted through contact with the blood or other body fluids of an infected person. It can be transmitted through sexual contact, sharing of needles, or from mother to child during childbirth.

Hepatitis B can lead to chronic infection, liver cirrhosis, and liver cancer. Prevention measures include safe injection practices, use of barrier methods during sexual activity, and universal vaccination.

Hepatitis C

Hepatitis C is primarily transmitted through contact with infected blood. It is often associated with unsafe injection practices, inadequate sterilization of medical equipment, and the transfusion of unscreened blood and blood products.

Hepatitis C can also lead to chronic infection, liver cirrhosis, and liver cancer. Prevention measures include harm reduction strategies, such as needle exchange programs, and the screening of blood and blood products.

Hepatitis D

Hepatitis D only occurs in individuals already infected with hepatitis B. It is transmitted through contact with infected blood or other body fluids.

Hepatitis D can worsen the outcome of hepatitis B, leading to a higher risk of liver cirrhosis and liver cancer. The best prevention measure is universal hepatitis B vaccination.

Hepatitis E

Hepatitis E is primarily transmitted through ingestion of contaminated food or water. It causes acute hepatitis, similar to hepatitis A, but can be particularly severe in pregnant women.

Prevention measures include improved sanitation, access to clean water, and personal hygiene.

Efforts towards elimination

In 2016, the World Health Organization (WHO) set a goal to eliminate viral hepatitis as a public health threat by 2030. The Global Health Sector Strategy on Viral Hepatitis outlines the key interventions and targets necessary to achieve this goal.

Vaccination

Vaccination is a crucial component of hepatitis elimination efforts. Vaccines are available to prevent both hepatitis A and hepatitis B.

Universal vaccination programs have proven to be highly effective in reducing the burden of these diseases in many high-income countries. However, coverage rates remain low in many low- and middle-income countries, where the burden of disease is highest.

Achieving universal hepatitis B vaccination coverage should be a priority to prevent new infections and reduce the prevalence of chronic hepatitis B.

Prevention and harm reduction

Prevention measures, such as improved injection safety, safe blood transfusions, and harm reduction strategies for high-risk populations, are essential to reduce the transmission of hepatitis B and C.

Harm reduction strategies include needle exchange programs, opioid substitution therapy for people who inject drugs, and promoting safe sexual practices. These interventions not only prevent new infections but also reduce the overall burden of disease.

Screening and testing

Early detection is crucial for effective hepatitis management. Regular screening and testing for hepatitis B and C can help identify individuals who are infected and ensure they receive appropriate care and treatment.

Access to affordable diagnostic tests and strengthening laboratory capacity in low-resource settings are essential to expand testing services and reach those in need.

Treatment and care

The availability of effective treatment options for hepatitis B and C has improved significantly in recent years. Direct-acting antiviral drugs have revolutionized the treatment landscape for hepatitis C, with cure rates exceeding 95%.

Similarly, antiviral medications can effectively suppress hepatitis B virus replication and reduce the risk of complications. Scaling up access to affordable treatment options, particularly in resource-limited settings, is critical to achieving the elimination targets.

The role of global collaboration

Achieving the goal of hepatitis elimination by 2030 requires strong global collaboration and political commitment.

The World Health Assembly adopted a resolution in 2010, calling for the development of a comprehensive global strategy to tackle viral hepatitis. The resulting Global Health Sector Strategy on Viral Hepatitis guides countries in their efforts to prevent, diagnose, and treat hepatitis, with the ultimate aim of eliminating viral hepatitis as a public health threat.

International partnerships, such as the World Health Organization, the World Hepatitis Alliance, and the Coalition for Global Hepatitis Elimination, provide technical support, advocacy, and resource mobilization to support countries in their elimination efforts. Sharing best practices, lessons learned, and innovative approaches are essential for accelerating progress towards the elimination targets.

Conclusion

Hepatitis is a global threat that affects millions of people and causes significant morbidity and mortality. However, with concerted efforts and political commitment, we can eliminate viral hepatitis as a public health threat by 2030.

Vaccination, prevention measures, screening and testing, and access to treatment and care are critical components of hepatitis elimination strategies. Global collaboration and partnerships are essential to support countries in their efforts and share knowledge and resources. Together, we can make a difference and secure a healthier future for generations to come.