Test. Treat. Hepatitis.

World Hepatitis Day

28 July 2018
 Viral hepatitis infections

• There are five main hepatitis viruses that cause acute and/or chronic
infection, referred to as types A, B, C, D and E.
• Hepatitis A and E are typically caused by ingestion of contaminated
food and water or through direct contact with an infectious person.
• Hepatitis B, C and D are typically caused by contact with
contaminated blood or body fluids.
• Hepatitis B and C are responsible for approximately 96% of all deaths
due to viral hepatitis in the world.
 Global burden of hepatitis B and C

• Viral hepatitis caused 1.34 million deaths in 2015, mainly from

cirrhosis or primary liver cancer due to chronic hepatitis B or C.
• Globally, in 2015, an estimated 257 million people were living with
chronic hepatitis B virus (HBV) infection, and 71 million people with
chronic hepatitis C virus (HCV) infection.
• Every day, thousands of people become infected – they lack access
to information and skills for prevention and are exposed to infection
through unsafe injection practices.

Source: WHO Global Hepatitis Report, 2017

 Hepatitis B and C – how it is transmitted
• Hepatitis B can be transmitted:
– through sexual contact
– from mother to child during or shortly after delivery
– through blood-to-blood contact, including among household contacts.

• Hepatitis C can be transmitted:

– through blood-to-blood contact, particularly through sharing of drug injection
equipment
– through sexual contact or from mother to child (less common).
 Hepatitis B and C in the WHO European Region
HBV
• Prevalence: 1.6% (1.2–2.6%)
• Persons living with HBV: 15 million (11–23 million)
• Estimated number of deaths: 56 000/year
HCV
• Prevalence: 1.5% (1.2–1.5%)
• Persons living with HCV: 14 million (11–14 million)
• Estimated number of deaths: 112 500/year

Over 60% of those affected live in eastern Europe and central Asia

Source: WHO Global Hepatitis Report, 2017

 New hepatitis B and C infections are still occuring
in the WHO European Region

HBV
• The exact number of new HBV infections leading to chronic hepatitis B is
unknown.
HCV
• Every year, 565 000 people are estimated to become infected with
hepatitis C, corresponding to about 1500 adults newly infected every day.
• New hepatitis C infections in the Region are almost one third of the global
figure.

Source: WHO Global Hepatitis Report, 2017

Get tested, demand treatment
Prompt testing and treatment of viral hepatitis B and
C can save lives
• Viral hepatitis B and C are root causes of liver cancer.
• Chronic hepatitis B and C may not show symptoms for
years or decades.

• Globally, over 60% of liver cancer cases are due to late

testing and treatment of viral hepatitis B and C.
Defeating hepatitis would greatly reduce liver cancer.
Treatment is available and effective
• Hepatitis C treatment with direct acting antivirals cure over
95% of patients and is much better tolerated than previous
interferon-based regimens.
• Many people diagnosed with hepatitis B will not require
treatment but should be regularly monitored. Treatment
should be provided to all those who need it.
• Chronic hepatitis B infection can be treated by oral antiviral
drugs, slowing progression and improving survival.
• Improving access to treatment remains a challenge in many
settings due to high costs.
 Elimination of viral hepatitis
as a public health threat by 2030

6–10 million infections (in

2015) to 900 000 infections
(by 2030)

1.4 million deaths (in 2015)

to under 500 000 deaths
(by 2030)
Elimination of viral hepatitis in the
WHO European Region
European Action plan on viral hepatitis
Goal: Eliminate viral hepatitis as a public health threat by
2030.
Five strategic directions:
1. information for focused action
2. interventions for impact
3. delivery for equity
4. financing for sustainability
5. innovation for acceleration.

Frameworks for action: universal health coverage;

continuum of services; promotion of a public health
approach.
 Regional essential targets by 2020
towards elimination of hepatitis
2015 BASELINE 2020 TARGET
HBV - vaccination
HBV - PMTCT*
Blood safety
Injection safety
Harm reduction Target 200 syringes /person
who inject drugs /year
HBV - diagnosis
HCV - diagnosis
HBV - treatment**
% coverage
HCV - treatment
0 25 50 75 100
*Measuring the progress on vertical transmission prevention is limited by data on pregnant women screening coverage
** Measuring the progress on HBV treatment is now limited by the absence of data on the proportion of persons eligible
PMTCT – prevention of mother-to-child transmission

*Source: WHO Global Hepatitis Report, 2017

 Resolution on Action plan 2016
(WHO Regional Committee for Europe resolution EUR/RC66/R/6)

• Align national viral hepatitis strategies with the

action plan and strengthen public health systems.
• Target individuals most affected and at risk.
• Facilitate partnerships to strengthen the response
to viral hepatitis and exchange of best practices
and experiences .
• Monitor and report to 69th and 72nd Regional
Committees (in 2019 and 2022) on implementation
of the action plan.
Towards stronger national plans – for an effective
and coordinated response

Global Health
Sector Strategy
Regional
action
frameworks National
strategies or
plans
 WHO response – guidelines on hepatitis
• July 2018 – updated WHO guidelines for the screening,
care and treatment of persons with hepatitis C infection.
• March 2015 – first WHO guidelines for the prevention,
care and treatment of persons with chronic hepatitis B
infection.
• February 2017 – first WHO hepatitis B and C testing
guidelines.
• The guidelines:
• use a public health approach and are aimed primarily at
policymakers; and
• are suitable for low- and middle-income countries and relevant for
high-income countries.
http://www.who.int/hepatitis/publications/hepatitis-c-guidelines/en/
http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
WHO/Europe support to countries in 2018 and beyond
• Implementation and monitoring of European Action plan.
• Technical assistance and country support with:
– national planning
– strategic information and surveillance
– updating of treatment and care guidelines
– strengthening of laboratory capacity
– advocacy and access to treatment.
• Collaboration with partners, including the European Centre for Disease
Control (ECDC), European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA), European Association for the Study of the Liver
(EASL), civil society and patients’ organizations.
 Challenges ahead

• Lack of global donors and commitment in many countries.

• Inadequate surveillance and monitoring systems.
• Most people living with hepatitis are still undiagnosed.
• Access to treatment limited by regulatory barriers and high prices.
• Structural or social barriers to providing people-centred services
for key vulnerable groups in the population.
Way forward to improve testing and treatment

• Promote a public health approach: provide integrated

people-centred care that leaves no one behind.
• Establish partnerships with governments, civil society and
the private sector.
• Take concrete and tailored action in countries, guided by
national plans.
Information and resources:
www.euro.who.int/hepatitis www.who.int/hepatitis

E-mail: eurohep@who.int