Giving Voice to the Silent Epidemic of Hepatitis
World Hepatitis Day—observed annually on July 28—is a day to remember the millions around the world, as well as those here in the U.S., who have lost their lives to or are suffering from viral hepatitis. It is also a day to celebrate the progress we have made to prevent millions of new infections so that we can at last foresee a day when viral hepatitis is no longer a major global public health threat.
Today, viral hepatitis is clearly one of our major immediate global health challenges. Viral hepatitis—a group of infectious diseases known as hepatitis A, B, C, D, and E—is responsible for more than 1.4 million deaths annually, mostly in lower and middle income countries, and is one of the most common causes of death due to infectious disease in the world. This is in the same range as the number of deaths from HIV/AIDS (1.7 million), tuberculosis (1.4 million) and malaria (700,000). The hepatitis B virus alone infects an estimated one in three people worldwide, and 400 million people live with chronic hepatitis B or C infection. Almost 80% of liver cancers are caused by viral hepatitis, and even among those infected who do not develop cancer, a significant portion will develop chronic liver disease.
However, with vaccines and education, most new cases of hepatitis infection are preventable. Over the past three decades, more than 1 billion doses of hepatitis B vaccine have been administered to children worldwide, preventing millions of new infections and deaths. Furthermore, because of innovative medicines, many of those who are infected are now able to live healthy lives.
There is, however, much left to be done. The public health concern regarding viral hepatitis is growing, because the viruses are easily transmitted from person to person. Because people may live for years without symptoms, millions do not even know they are infected, and since they may become ill decades after infection, viral hepatitis is known as a “silent epidemic.” Knowing one’s status is important not only to prevent further infections, but also so people can access highly effective medicines and learn about the simple lifestyle changes they can make to keep themselves healthy. HHS’s Centers for Disease Control and Prevention works closely with the World Health Organization (WHO) and in partnership with countries’ ministries of health to improve hepatitis surveillance and develop national strategies to address the virus.
A key concern about hepatitis is the alarming rates of coinfection among people living with HIV. In sub-Saharan Africa, the prevalence of hepatitis B coinfection among people living with HIV is as high as 17% in some regions and as high as 60-90% among HIV-positive injecting drug users. Coinfection is a leading complication for both HIV and hepatitis, and a focus of the U.S. government’s global health work. In fact, a major cause of illness and death in Africa is not from HIV alone, but from complications of HIV-hepatitis coinfection. Coinfection is linked with more rapid progression of viral hepatitis-related liver disease, and coinfection often complicates the management of a person’s HIV disease and can lead to serious, life-threatening consequences.
In an example of positive synergy, the work the U.S. government does to address one of these deadly viruses in turn affects efforts to respond to the other. For example, funds from the U.S. government’s global AIDS program, PEPFAR, have been used to make safe blood banks available in countries where the blood supply was formerly extremely limited and often contaminated. As a result, blood is now screened carefully so that both HIV and hepatitis viruses no longer go undetected. These safety improvements—that have already significantly reduced hepatitis infections in the U.S. and other high-resource countries—are now doing to same in some low-resource countries thanks to U.S. assistance.
WHO designated July 28 as World Hepatitis Day in 2010 to better promote understanding, education and advocacy about viral hepatitis. In doing this, WHO sought to encourage better understanding of disease prevention and control measures. We recognize that a key part of prevention must be encouraging active collaboration between HIV and hepatitis efforts, since—despite shared modes of transmission and high levels of coinfection—many prevention strategies and treatment services continue to focus on just one of these infections. Siloed disease control efforts are not good public health practice; program collaboration and service integration can enhance disease prevention and have a greater overall impact on the well-being of those at risk for and infected with these diseases. I am proud of the U.S. partnerships in this global response to viral hepatitis and look forward to the progress we will make together in the years ahead.
