Viral hepatitis continues to be one of the deadliest infections in the world, attributed as the cause of one death every 25 seconds, as well as being identified as the leading cause of liver cancer in the world.  Most cases of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are in Asia, so it is important to quantify the disease burden in Asia to help international agencies, public health organizations and policy-makers develop strategies to eliminate these infections.

Today, there are many treatments to eliminate viral hepatitis.  With the availability of vaccines that can effectively prevent Hepatitis B, many countries have adopted large-scale vaccination practices for infants, one such example being China. Treatment for Hepatitis B has also been developed for patients who had been infected prior to the availability of vaccines, and existing treatments for Hepatitis C can cure patients within the span of 12 weeks.  However, many cases of HBV and HCV still remain untreated to this day.

Since 2018, the ZeShan Foundation has been providing funding to the Center for Disease Analysis Foundation in their efforts to help countries in Asia eliminate hepatitis B and C in the region.  To study and publish a report on the breadth of hepatitis B and C burden across Asia, the CDA Foundation worked closely with Asian countries to collect data on the number of people infected, diagnosed, and treated. In this project, mathematical models were used to estimate the impact of viral hepatitis in Asia, the summary of which is shown below.  From the data collected, an estimate of 188 million people in Asia are infected with hepatitis B (Figure 1) and another 34 million with hepatitis C (Figure 2).  For more details, please view the CDA Foundation’s website:  https://cdafound.org/dashboard/polaris/dashboard.html.

The compiled research reveals that a majority of global HBV- and HCV-related cases of liver cancer and liver related deaths are concentrated in Asia (Figure 3).  This analysis will help Asian countries obtain more funding for the elimination of viral hepatitis, and additionally recruit support from their government to test and treat this population through HBV vaccinations.

Fig. 1  An estimate 188 million people in Asia were infected with hepatitis B

Fig. 2  34 million people in Asia were infected with hepatitis C

Fig. 3  A majority of global HBV- and HCV-related cases of liver cancer and liver related deaths are concentrated in Asia

Since 2013, ZeShan Foundation has been providing support to the World Health Organisation Office for the Western Pacific Region (WPRO). ZeShan’s grants aid WPRO in combating viral hepatitis in the region, and includes the allocation of specific support to the China office.

Viral hepatitis is responsible for 1.4 million deaths globally. There are estimated to be 115 million people with chronic hepatitis B (HBV) infection and 14 million with chronic hepatitis C (HCV) infection living in the Western Pacific Region, accounting for 40 % of people burdened with chronic hepatitis B and C across the globe. 

Chronic HBV and HCV is known to lead to the development of cirrhosis and liver cancer over time. With 60% of the worlds’ affected population, the Western Pacific Region has the highest number of deaths caused by liver cancer globally, which is also the 6th top cause of death in the region. Six of the top ten countries with the highest incidence (new annual cases) of liver cancer in the world include Mongolia (highest incidence globally), Viet Nam, Lao People’s Democratic Republic, Cambodia, China and South Korea.  This being said, early testing and treatment can effectively reduce the progression of these diseases and subsequently the risk of development of liver cancer.   

Patient Story (Philippines): https://www.who.int/philippines/news/feature-stories/detail/surviving-hepatitis-b-and-liver-cancer-vhal-s-story

News feature: https://www.montsame.mn/en/read/136120    World Hepatitis Day in Mongolia, 2018

The grant support from ZeShan Foundation has vaulted WPRO into leading the action on viral hepatitis in the Region, and has allowed the organization to establish regional responses in the effort to eliminate viral hepatitis as outlined by the Global Health Sector Strategy for Viral Hepatitis 2016-2021 . With the elimination of viral hepatitis being highlighted within the 2030 Sustainable Development Goals, the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016-2020  has been endorsed by all countries in the Western Pacific Region, which defines specific actions to be taken in order to better understand hepatitis epidemics. The outlined actions include awareness and knowledge building among stakeholders, strengthening public policy, and data generation, which will also be essential factor in the process of enhancing prevention strategies and improving access to affordable screening, diagnosis and treatment of hepatitis B and C.

Figure 1 illustrates the current progress in hepatitis response programmes in the Western Pacific Region, which underscores the critical importance of national leadership, development of national response plans and having data to inform policy and decision making.

Source: WHO Western Pacific Regional Office, January 2021.

Supporting countries to scale up interventions towards hepatitis elimination

The Western Pacific Region has led global efforts in working towards hepatitis elimination. Some of the regional successes include the triple elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B, as well as the scaled up hepatitis testing and treatment encompassed in Universal Health Coverage. See more here in country case studies[1]  [2]   – China, Triple elimination, Mongolia, Malaysia

Links:

Link to overall WPRO hepatitis website: https://www.who.int/westernpacific/health-topics/hepatitis

Building capacity of healthcare providers

It is critical to ensure that healthcare providers are trained to deliver good quality hepatitis care and treatment. WPRO has published Training Modules on Hepatitis B and C Screening, Diagnosis and Treatment[1] in collaboration with the WHO South East Asia Region and other WHO centers.

[1] WPRO-SEARO clinical training modules, published July 28, 2020

https://www.who.int/southeastasia/publications-detail/9789290227472

 WPRO-SEARO clinical modules

https://www.who.int/southeastasia/publications-detail/9789290227472

Raising public awareness on viral hepatitis

To improve awareness around viral hepatitis and its impact on health, WHO offices in all countries work closely with the Ministries of Health and their partners to provide information to the public. Every year, awareness is raised globally through World Hepatitis Day on 28th July.

Link to videos: (snapshot)

Link to video on hepatitis (mash-up) https://youtu.be/Xl1hRjm-Uhk

WPRO-SEARO clinical training modules, published July 28, 2020

https://www.who.int/southeastasia/publications-detail/9789290227472

Philippines: scaling up hepatitis B services during the COVID-19 lockdowns (video World Hepatitis Day 2020): https://www.facebook.com/whophilippines/videos/291155845324695

Malaysia – Yap’s Story: Road to Recovery (a story of HIV and HCV for World AIDS Day 2020):  https://www.youtube.com/watch?v=D-6T-J0Sd10

Malaysia – Silas’s Story: Road to Recovery (World Hepatitis Day 2020):  https://www.youtube.com/watch?v=5aBstAHJ-0M&feature=youtu.be

Viet Nam – Chiến thắng bệnh viêm gan C | Successful fight against hepatitis C (World Hepatitis Day 2020): https://www.youtube.com/watch?v=KjT3r6OCxdY&t=48s

WHO country office China – 面对肝炎，做好检测，及早治疗，活出最好的自己 (World Hepatitis Day 2020): https://v.qq.com/x/page/o0530ahwxel.html

WHO country office China –消除歧视，消除肝炎 (World Hepatitis Day 2020): https://v.qq.com/x/page/d0530xpdu1y.html

WHO country office Mongolia – World Hepatitis Day 2020: https://www.facebook.com/WHO.MGL/videos/981267499003176