By Savanna Henderson, Humanitas Global
Globally, over 1 million people die a year from disease caused by viral hepatitis. There are five main hepatitis viruses, A, B, C, D and E that can cause illness and/or death. Worldwide, 400 million people are living with hepatitis B or C (HBV and HCV), which are the most common causes of liver cirrhosis and cancer. Yesterday was World Hepatitis Day and events were held worldwide, with a focus on preventing HBV and HCV. Key messages of the 2015 World Hepatitis Day are:
- Know the risks
- Demand safe injections
- Vaccinate children
- Get tested, seek treatment
In this two-part blog post, we will examine the risk factors associated with HBV and HCV, barriers to prevention and treatment, and how we as a global society can prevent further infection and death caused by viral hepatitis.
What is hepatitis?
Hepatitis is inflammation of the liver, often caused by a virus. Hepatitis B and C can lead to chronic disease and later, cirrhosis and liver cancer.
What is hepatitis B?
Despite there being a vaccine for HBV, an estimated 240 million people are chronically infected. HBV is transmitted from mother to child, through contact with infected blood, saliva, and seminal and vaginal fluids. Many adults naturally recover from HBV but others will progress to become carriers or develop chronic hepatitis. Treatment for HBV can slow the progression of cirrhosis and prevent replication of the virus, but it cannot cure HBV; those infected with HBV will have to remain on treatment for the rest of their lives.
What is hepatitis C?
There is no vaccine for HCV so, primary prevention of the infection focuses on reducing the risk of exposure, especially in high risk populations, and screening for the virus. HCV is transmitted through exposure to infected blood and is sometimes sexually transmitted. Acute HCV infections are often asymptomatic, meaning that early diagnosis is rare. Although there is a cure for HCV, limited access to both diagnosis and treatment can reduce the chance that infected persons will be cured.
Transmission Trends
Unsafe injection practices, poor infection control, and use of unscreened blood all contribute to ongoing transmission of both HBV and HCV. Sub-Saharan Africa encompasses 20% of global infections but fewer than 50% of the regions blood banks are tested for HBV and HCV. Of the 3 to 4 million new cases of HCV annually, unsafe healthcare practices in low- income countries account for over 2 million of these new infections. HCV is found worldwide but the burden is highest in Africa and Central and East Asia. HBV is highly prevalent in sub-Saharan Africa and East Asia where it is most commonly spread from mother to child at birth or through exposure to infected blood before the first five years of life. An additional cause of HBV infection includes sexual transmission, especially unprotected. HBV is the only sexually transmitted infection that has a protective vaccine.
In high- and middle- countries, people who inject drugs (PWID) are among the most prevalent to carry HBV and HCV. It is estimated that 11.2 million PWIDs are infected with HBV or HCV. PWIDs can be the recipients of prejudiced, lesser quality medical treatment, which further hampers follow-up, treatment, and knowledge regarding transmission. Stigma and a lack of awareness on the disease can fuel discrimination against carriers. For example, despite a law prohibiting discrimination against persons carrying infectious diseases, HBV carriers in China face employment discrimination, with many workplaces mandating pre-employment HBV screenings. Although China banned HBV tests in job and school admissions applications in 2010, a 2011 survey showed that 61% of state-run companies continued using the test as a pre-employment scan and 32% of surveyed kindergarten schools stated that they would deny enrollment to children with HBV.
Co-infection
Globally, 4 to 5 million people are co-infected with both HCV and HIV. It is still unclear as to the extent HCV is spread through sexual contact, but research reveals that those who are HIV-positive, especially men who have sex with men (MSM), are at a greater risk for HCV. More than 70% of HIV-infected people have had or currently have HBV and MSM have higher rates of coinfection than PWIDs or heterosexuals. Those with HIV can be subject to discrimination, marginalization, and even criminalization in some areas, which reduces their chances of seeking out and receiving preventative information, screening, and treatment. This carries over to those co-infected with HIV and hepatitis; governmental, healthcare, employment, and community level discrimination dissuades people from seeking out and receiving adequate care.
Learning about viral hepatitis, and associated risks, is the first step in preventing further transmission. Furthermore, it is crucial to understand the obstacles such as discrimination, misinformation, and access, preventing people from taking precautionary measures or seeking treatment so that actions can be taken to eliminate these barriers. As the World Hepatitis Day campaign states it, “Viral hepatitis can be prevented. It’s up to all of us to act”.
