What we need to know about hepatitis

Published On: July 28, 2018 01:25 AM NPT By: Dr Poonam Khetrapal Singh

Viral hepatitis can be prevented, tested for, treated and in many cases cured. Its elimination is both possible and necessary 

There are few infectious diseases as amenable to control and elimination as viral hepatitis. In fact, WHO South-East Asia and its member states’ quest to eliminate viral hepatitis as a public health threat by 2030 is readily achievable, despite the disease currently killing an estimated 410 000 in our region annually—more than HIV and malaria combined.

Sounds like a long arrow to draw? Let me explain. 

First, viral hepatitis’ spread is 100 percent preventable. Routine immunization, safe blood, safe sex and safe needle usage among other measures can prevent hepatitis B and C infections. Clean food and good personal hygiene, along with access to safe water and sanitation, can meanwhile guard against hepatitis A and E.

Second, viral hepatitis can be rapidly and inexpensively tested for and detected. So much so that whole birth cohorts or high-risk populations can—regardless of whether symptoms are experienced—be easily tested and provided an accurate diagnosis. That provides immense opportunities to find the millions of missing viral hepatitis cases, to ensure infected persons receive the care they need, and to stop the disease’s progression and spread. 

And finally, powerful new drugs are available to treat hepatitis B and cure hepatitis C in nearly 95 percent of cases. In recent years, countries across the South-East Asia Region have taken advantage of these developments by registering and licensing many of these drugs, while also leveraging flexibilities in global trade agreements to drive down costs and increase access, thereby helping close treatment gaps.

Gaps in treatment 
Those gaps, however, remain significant. Indeed, they are the leading cause of hepatitis’ outsized burden across the region. General lack of awareness is the primary reason. Less than one in ten infected people, for example, are estimated to be aware of their status, while less than 10 percent of those who do know their status are receiving appropriate treatment. That is particularly problematic given that 40 million people in the region are estimated to live with hepatitis B and around 10 million with hepatitis C. 

A large majority of them are at risk of progressive liver damage and a series of life-threatening conditions such as fibrosis and cancer of the liver.

It is for precisely these reasons that WHO South-East Asia’s Regional Action Plan for Viral Hepatitis focuses on the need to find, test and treat every case of viral hepatitis, with a specific emphasis on increasing awareness of the disease’s signs and symptoms and making many treatment options available. As per the Plan’s targets, by 2020 at least 50 percent of infected people should know their status and at least 75 percent of those diagnosed with the disease should be provided treatment by the same deadline.

Importantly, at least 90 percent of newborns should receive the hepatitis B vaccine’s birth dose, while at least 95 percent of children should complete the vaccine’s three-dose schedule. Increased injection safety in health facilities is likewise critical.

Three solutions 
In noting the range of challenges faced, however, by focusing attention on three key areas, member states can achieve rapid, game-changing progress.

First among them is enhancing knowledge and awareness of viral hepatitis among high-risk groups, civil society and the public more generally. Health authorities region-wide should deploy clear messaging regarding how viral hepatitis can be prevented, its signs and symptoms and where people can get tested and treated. Not only will this help stop the disease’s transmission; it will also ensure more people are aware of their status. Health authorities should also build health workers’ capacity to better detect hepatitis and ensure all suspected cases are tested. To do that, health workers must have access to quality point-of-care diagnostics and laboratory testing. All testing kits, for example, should be affordable and quality assured. Results should meanwhile be communicated to individuals confidentially and without prejudice or stigma. Significantly, viral hepatitis testing should be integrated with HIV, antenatal care and cancer screening and treatment services. It should also occur under a clear set of national viral hepatitis testing guidelines.

Where individuals test positive for hepatitis B or C, access to effective and affordable treatment is vital. While treatments have existed for hepatitis B for some time, directly-acting antiviral drugs can now cure almost all cases of hepatitis C. To further increase access, member states should enhance their use of flexibilities in global trade agreements, increase investment in what are life-saving treatments, expand the number of drugs registered and licensed, and consider adding them to their national lists of essential medicines. Member states should also earmark adequate funds for national hepatitis action plans.

WHO South-East Asia is committed to supporting its member states pursue each of these priority actions and ensuring the Regional Action Plan is fully implemented. Indeed, given that knowledge really is power, together we have the means to eliminate viral hepatitis’ unnecessary burden, to save more than 400 000 lives a year, and to create a region that is healthier, happier and stronger than ever before. 

The author is the Regional Director of World Health Organization, South-East Asia region

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