World Hepatitis Day 2017

Each year, the World Health Organization (WHO) marks July 28th as World Hepatitis Day in order to increase the awareness and public health significance of viral hepatitis, especially hepatitis B and C. The World Hepatitis Day begins to mark on this date since 2010, in honor of the birthday of Nobel laureate Baruch Samuel Bloomberg – an American scientist honored to detect hepatitis B virus (HBV) and develop a vaccine against this virus.

The seventh World Hepatitis Day, on July 28, 2017, is marked under the motto “Elimination of hepatitis,” as foreseen in the first “Global Strategy of the Health Sector for Viral Hepatitis 2016-2021″ and is included as the ultimate goal for viral hepatitis on the Agenda for Sustainable Development – 2030, WHO.

Elimination of hepatitis can be achieved by increasing public awareness, education and information, testing and timely diagnosis, appropriate treatment, vaccination against hepatitis B according to routine immunization programs, providing controlled blood and blood derivatives for safe transfusion and risk prevention of drug use. Any activity aimed at preventing and treating hepatitis means approaching the goal of its elimination. The fact that there is an effective and affordable vaccine against hepatitis B virus that can successfully prevent this disease and the use of the latest generation of drugs that successfully treat chronic hepatitis C give strong hope that the goal of eliminating the hepatitis will have success in the future

The different types of hepatitis viruses occurring around the world

The five hepatitis viruses – A, B, C, D and E – are distinct; they can have different modes of transmission, affect different populations, and result in different health outcomes.

• Hepatitis A (HAV)is primarily spread when someone ingests the virus from contact with food, drinks, or objects contaminated by feces from an infected person or has close personal contact with someone who is infected. Hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause serious symptoms. Hepatitis A can be prevented through improved sanitation, food safety, and vaccination.
• Hepatitis B(HBV) is often spread during birth from an infected mother to her baby. Infection can also occur through contact with blood and other body fluids through injection drug use, unsterile medical equipment, and sexual contact. Hepatitis B is most common in sub-Saharan Africa and Asia, but is also high in the Amazon region of South America, the southern parts of eastern and central Europe, the Middle East and the Indian subcontinent. The hepatitis B virus can cause both acute and chronic infection, ranging in severity from a mild illness lasting a few weeks to a serious, chronic illness. If infected at birth or during early childhood, people are more likely to develop a chronic infection, which can lead to liver cirrhosis or even liver cancer. Getting the hepatitis B vaccine is the most effective way to prevent hepatitis B. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, followed by 2-3 additional doses. In many parts of the world, widespread infant vaccination programs have led to dramatic declines of new hepatitis B cases.
• Hepatitis C(HCV) is spread through contact with blood of an infected person. Infection can occur through injection drug use and unsafe medical injections and other medical procedures. Mother-to-child transmission of hepatitis C is also possible. Hepatitis C can cause both acute and chronic infections, but most people who get infected develop a chronic infection. A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer. With new treatments, over 90% of people with hepatitis C can be cured within 2-3 months, reducing the risk of death from liver cancer and cirrhosis. The first step for people living with hepatitis C to benefit from treatments is to get tested and linked to care. There is currently no vaccine for hepatitis C but research in this area is ongoing.
• Hepatitis D (HDV)is passed through contact with infected blood. Hepatitis D only occurs in people who are already infected with the hepatitis B virus. People who are not already infected with hepatitis B can prevent hepatitis D by getting vaccinated against hepatitis B.
• Hepatitis E(HEV) is spread mainly through contaminated drinking water. Hepatitis E usually clears in 4-6 weeks so there is no specific treatment. However, pregnant women infected with hepatitis E are at considerable risk of mortality from this infection.  Hepatitis E is found worldwide, but the number of infections is highest in East and South Asia. Improved sanitation and food safety can help prevent new cases of hepatitis E. A vaccine to prevent hepatitis E has been developed and is licensed in China, but is not yet available elsewhere

In the Republic of Macedonia, the vaccine against hepatitis B has been introduced in the Immunization Calendar as a compulsory vaccination since 2004. Vaccination includes all newborns, and is carried out by giving three doses of hepatitis B vaccine.

Hepatitis in the world and in Macedonia

According to WHO, in 2015, 325 million people were infected in the world, and 1.34 million people died from viral hepatitis, a number close to the number of tuberculosis deaths and a number that exceeds deaths related to HIV. It is estimated that 257 million people live with hepatitis B and 71 million people live with hepatitis C – the two major killers of the five types of hepatitis.

In 2016, in Macedonia were registered 20 cases of Viral hepatitis type A with an incidence of 1.0 to 100.000 inhabitants, which is a decrease of 87.3% compared to the previous year when 157 cases and an incidence of 7.6 / 100.000 were registered. In the previous ten-year period, the lowest incidence was recorded in 2013 (4.9 / 100.000) and the highest in 2014 (28.2 / 100.000). In the past ten years, there has been a downward trend in this disease (Chart 1).

As of June 2017, a total of 11 new cases of hepatitis A have been registered.

Chart 1. Incidence of 100,000 inhabitants of hepatitis A, period 2006-2015 and 2016

Viral hepatitis B is registered in 2016 with 104 cases (I = 5,0 / 100.000), which is a reduction of 29.7% compared to 148 cases reported in 2015. The incidence in 2016 was lower by 41.2% compared to the average for the 2006-2015 when the incidence ranges from 7.2 in 2015 to 10.5 per 100,000 in 2007. In the period 2006-2016, a total of 10 deaths from Hepatitis B have been reported (Table 1).

In the course of 2017 (as of June), 41 cases of hepatitis B infection have been reported.

Table 1. Number of cases of death / incidence per 100,000 inhabitants of Hepatitis B, period 2006-2015 and 2016

Viral hepatitis C in Macedonia in 2016 was registered with 45 cases (I = 2,2 / 100.000), a decrease of 25.0% compared with 60 registered cases (I = 2,9 / 100.000) in the previous year.

The registered incidence of hepatitis C in 2016 is lower by 52.2% than the average for the previous ten-year period of 2006-2015 when the incidence per 100,000 populations ranged from 2.9 in 2015 to 8.1 in 2012, or an average of 4.6 /100.000. In the period 2006-2016, two deaths were registered in 2012 and 2016 (Table 2). As of June 2017, 13 new cases of hepatitis C have been recorded.

Prevention

Primary prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.

The following list provides a limited example of primary prevention interventions recommended by WHO:

• hand hygiene: including surgical hand preparation, hand washing and use of gloves;
• safe and appropriate use of health care injections;
• safe handling and disposal of sharps and waste;
• provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment;
• testing of donated blood for hepatitis B and C (as well as HIV and syphilis);
• training of health personnel; and
• promotion of correct and consistent use of condoms.

The spread of hepatitis A can be reduced by:

• adequate supplies of safe drinking water;
• proper disposal of sewage within communities; and
• personal hygiene practices such as regular hand-washing with safe water.

Secondary and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends:

• education and counselling on options for care and treatment;
• immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses and to protect their liver;
• early and appropriate medical management including antiviral therapy if appropriate; and
• regular monitoring for early diagnosis of chronic liver disease.