In a report documenting multiple missed opportunities to detect, treat, cure, and prevent transmission of hepatitis B and C viruses, the World Health Organization recently released its first global estimates of the impact of the infections, showing their toll in 2015 exceeded deaths caused by HIV, and was comparable to the number of deaths caused by tuberculosis.
An estimated 1.35 million people died as a result of viral hepatitis in 2015, reflecting a 22 percent increase in deaths due to liver inflammation caused by a virus, the report notes. About 97 percent of those deaths are caused hepatitis B, which is concentrated in the African and Western Pacific regions, and hepatitis C, which is distributed more widely across the world, according to the report. Worldwide about 325 million people are living with the viruses.
Most of the 257 million people living with hepatitis B became infected before the advent and accessibility of a vaccine against the virus introduced over the last three and a half decades. But while the three dose vaccine is most effective if the first dose is given at birth, only about 39 percent of babies are vaccinated at birth, and rates of the disease among children in Africa continue to hover around 3 percent, according to the report. Deaths will continue to rise among people already infected if they are not diagnosed and treated, the report points out. But in 2015 only 9 percent of people living with hepatitis B had been diagnosed, and only 20 percent of people living with hepatitis C knew it, according to the report. No more than 8 percent of people diagnosed with hepatitis B began treatment, and about 7 percent of those with hepatitis C did.
And while no vaccine exists to prevent hepatitis C infection, medicines that cure the virus were approved in 2013 and 2014. But the report notes, those medicines, Solvadi and Harvoni, from Gilead, remain out of reach of most with the cost of a course of treatment running as high as $84,000. The vast majority of people treated for hepatitis C continue to receive older, less effective, and more toxic regimens, according to the report. Policies to increase access and affordability of the new direct acting antiviral drugs that cure the infection are critical to reversing rates of both new infections and deaths, the report says. In addition, the report notes, efforts to address unsafe injection practices, the primary mode through which that virus is transmitted would have significant impact. Globally five percent of medical injections remain unsafe, according to the report, while provision of measures to reduce harm from injecting drug use, including needle and syringe exchange programs and opioid substitution therapy remains “inadequate.”
Political leadership makes a difference, the report says, noting some areas where opportunities are being seized, where diagnostic tests cost as little as 5 cents, where hepatitis B treatment costs as little as $48 a year, and, in some countries, where a course of treatment to cure hepatitis C costs $200.
The full report is available here.