International efforts to tackle the hepatitis pandemic have reached new heights, especially in the past year since the 69th World Health Assembly (WHA) endorsed the Global Health Sector Strategy (GHSS) on viral hepatitis 2016–2021.
It is estimated that some 325 million people worldwide are living with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection alone, and a large portion of these people lack access to life-saving testing and treatment. As a result, millions are at risk of chronic liver disease, cancer and death.
To this end, the GHSS calls for the elimination of all types of viral hepatitis (A, B, C, D & E) as a public health threat by 2030 ‒ reducing new infections by 90% and mortality by 65%. Indeed, mortality caused by viral hepatitis is on the rise, with 1.4 million deaths believed to be caused by the disease in 2015. The focus is on HBV and HCV, both blood-borne infections that are responsible for 96% of all hepatitis mortality.
On a positive note, a Global Hepatitis Report published by the World Health Organization (WHO) in April 2017 says that eliminating viral hepatitis is “technically feasible”.
Medical technology will play a critical role.
The report points out, for example, that key innovations include rapid serological tests to detect antibodies to HCV as well as point-of-care tests to diagnose HCV infection. Newer and cheaper point-of-care rapid tests, such as those for HBV and affordable ones for HCV, could accelerate the elimination of hepatitis.
The WHO’s first-ever viral hepatitis testing guidelines recommend the use of rapid diagnostic tests for hard-to-reach populations and targeted testing in groups most affected by HBV and HCV, such as people who inject drugs, those with HIV and children of mothers with HBV or HCV infection. Simple and effective hepatitis testing strategies are lacking, and few people with chronic HBV and HCV hepatitis infection even know their status. The guidelines emphasise that hepatitis testing is the gateway for access to both prevention as well as care and treatment services.
Indeed, the WHO is developing an Essential Diagnostics List (EDL), which will include tests for HBV and HCV, among other initial priority areas. “It’s clear that treatment of an illness will not be effective if it is not diagnosed correctly,” says Dr Suzanne Hill, WHO Director of Essential Medicines and Health Products. “The EDL will be another useful tool to help countries address their disease burden by focusing on evidence-based diagnostic tools.”
It is interesting to note that several new laboratory technologies are available, or are being developed, to simultaneously test for various diseases including hepatitis. For example, a single device may be able to test for the presence of tuberculosis and HIV, and quantitatively measure HIV and hepatitis C viral load. “In settings where laboratory testing has been traditionally organised by disease programme, the introduction of multi-disease testing devices brings new opportunities for collaboration and integration, which can provide significant system efficiencies and cost savings, increase patient access, and ultimately improve quality of care,” says a recently published WHO Information Note on the topic.
Transmission of HBV and HCV often occurs through unsafe injections and medical procedures. Reducing healthcare-associated infections (HAIs) is therefore a key component of any hepatitis public health strategy. The GHSS sets a target for increasing the percentage of medical injections administered with safety-engineered devices (e.g. reuse prevention and needle-stick injury protection syringes) from a baseline of 5% in 2015 to 50% in 2020 and 90% in 2030.
At the European level, the WHO European Regional Committee last September approved an Action plan for the health sector response to viral hepatitis in the WHO European Region. Among other priority actions for EU Member States are the revision of national sterilisation and disinfection guidelines in healthcare settings and the implementation of medical measures to promote universal use of safety-engineered devices for all therapeutic injections. This aligns with GHSS goals.
The WHO and partners including the World Hepatitis Alliance have organised two high-profile global initiatives this year to advocate for an urgent response to viral hepatitis. The first is World Hepatitis Day on 28 July, with the theme “Eliminate Hepatitis”. The second is the annual World Hepatitis Summit to be held from 1-3 November in São Paulo, Brazil.