​21 APRIL 2017 | GENEVA, AMSTERDAM - New WHO data reveal that an estimated 325 million people worldwide are living with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The WHO Global hepatitis report, 2017 indicates that the large majority of these people lack access to life-saving testing and treatment. As a result, millions of people are at risk of a slow progression to chronic liver disease, cancer, and death.

"Viral hepatitis is now recognized as a major public health challenge that requires an urgent response," said Dr Margaret Chan, WHO Director-General. "Vaccines and medicines to tackle hepatitis exist, and WHO is committed to helping ensure these tools reach all those who need them."

Increasing mortality, new infections
Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and HIV. But while mortality from tuberculosis and HIV has been declining, deaths from hepatitis are on the increase.

Approximately 1.75 million people were newly infected with HCV in 2015, bringing the global total of people living with hepatitis C to 71 million.
​
Although overall deaths from hepatitis are increasing, new infections of HBV are falling, thanks to increased coverage of HBV vaccination among children. Globally, 84% of children born in 2015 received the 3 recommended doses of hepatitis B vaccine. Between the pre-vaccine era (which, according to the year of introduction can range from the 1980s to the early 2000s) and 2015, the proportion of children under 5 years of age with new infections fell from 4.7% to 1.3%. However, an estimated 257 million people, mostly adults born before the introduction of the HBV vaccine, were living with chronic hepatitis B infection in 2015.

Epidemics in regions and "hotspots"

Hepatitis B levels vary widely across WHO regions with the WHO African Region and WHO Western Pacific Region sharing the greatest burden.

• WHO Western Pacific Region: 6.2% of population (115 million people)
• WHO African Region: 6.1% of population (60 million people)
• WHO Eastern Mediterranean Region: 3.3% of population (21 million people)
• WHO South-East Asia Region: 2% of population (39 million people)
• WHO European Region: 1.6% of population (15 million people)
• WHO Region of the Americas: 0.7% of population (7 million people)

Today, unsafe injections in health care settings and injecting drug use are considered to be the most common routes of HCV transmissions. HCV prevalence by WHO region is:
​

• WHO Eastern Mediterranean Region: 2.3% of population (15 million people)
• WHO European Region: 1.5% of population (14 million people)
• WHO African Region: 1% of population (11 million people)
• WHO Region of the Americas: 1% of population (7 million people)
• WHO Western Pacific Region: 1% of population (14 million people)
• WHO South-East Asia Region: 0.5% of population (10 million people)

Treatment access is low

There is currently no vaccine against HCV, and access to treatment for HBV and HCV is still low.
WHO's Global Health Sector Strategy on viral hepatitis aims to test 90% and treat 80% of people with HBV and HCV by 2030.

The report notes that just 9% of all HBV infections and 20% of all HCV infections were diagnosed in 2015. An even smaller fraction – 8% of those diagnosed with HBV infection (1.7 million people) were on treatment, and only 7% of those diagnosed with HCV infection (1.1 million people) had started curative treatment during that year.

HBV infection requires lifelong treatment, and WHO currently recommends the medicine tenofovir, already widely used in HIV treatment. Hepatitis C can be cured within a relatively short time using the highly effective direct-acting antivirals (DAAs).
​
"We are still at an early stage of the viral hepatitis response, but the way forward looks promising," said Dr Gottfried Hirnschall, Director of WHO's Department of HIV and the Global Hepatitis Programme. "More countries are making hepatitis services available for people in need – a diagnostic test costs less than US$ 1 and the cure for hepatitis C can be below US$ 200. But the data clearly highlight the urgency with which we must address the remaining gaps in testing and treatment."

Country progress

WHO's Global hepatitis report, 2017 demonstrates that despite challenges, some countries are taking successful steps to scale-up hepatitis services.

China achieved high coverage (96%) for the timely birth dose of HBV vaccines, and reached the hepatitis B control goal of less than 1% prevalence in children under the age of 5 in 2015. Mongolia improved uptake of hepatitis treatment by including HBV and HCV medicines in its National Health Insurance scheme, which covers 98% of its population. In Egypt, generic competition has reduced the price of a 3-month cure for hepatitis C, from US$ 900 in 2015, to less than US$ 200 in 2016. Today in Pakistan, the same course costs as little as US$ 100.
​
Improving access to hepatitis C cure received a boost at the end of March 2017, when WHO prequalified the generic active pharmaceutical ingredient of sofosbuvir. This step will enable more countries to produce affordable hepatitis medicines

Baseline for elimination

WHO's Global hepatitis report, 2017 aims to provide a starting point for hepatitis elimination by indicating baseline statistics on HBV and HCV infections, including mortality, and coverage levels of key interventions. Hepatitis B and C – the 2 main types out of 5 different hepatitis infections – are responsible for 96% of overall hepatitis mortality.

Notes for editors
​
World Immunization Week (24–30 April): WHO recommends the use of vaccines against 26 diseases, which include 3 vaccine-preventable types of viral hepatitis (A,B and E) out of 5 types of viral hepatitis (A,B,C,D,E).

World Hepatitis Day 2017 and World Hepatitis Summit 2017: WHO and partners will organize 2 high-profile global initiatives to advocate for an urgent response to viral hepatitis. World Hepatitis Day 2017 will be commemorated on 28 July under the theme “Eliminate hepatitis”. The World Hepatitis Summit 2017, the principal convention of the global hepatitis community, is being co-organized by WHO, the Government of Brazil and the World Hepatitis Alliance. It will be held on 1–3 November 2017 in São Paulo, Brazil.
 
​
Source:  World Health Organization

CDC Report’s Abstract (U.S. Department of Health and Human Services - Centers for Disease Control and Prevention)

Background: In collaboration with state, tribal, local, and territorial health departments, CDC established the U.S. Zika Pregnancy Registry (USZPR) in early 2016 to monitor pregnant women with laboratory evidence of possible recent Zika virus infection and their infants.

Methods: This report includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the USZPR from January 15 to December 27, 2016. Birth defects potentially associated with Zika virus infection during pregnancy include brain abnormalities and/or microcephaly, eye abnormalities, other consequences of central nervous system dysfunction, and neural tube defects and other early brain malformations.

Results: During the analysis period, 1,297 pregnant women in 44 states were reported to the USZPR. Zika virus–associated birth defects were reported for 51 (5%) of the 972 fetuses/infants from completed pregnancies with laboratory evidence of possible recent Zika virus infection (95% confidence interval [CI] = 4%–7%); the proportion was higher when restricted to pregnancies with laboratory-confirmed Zika virus infection (24/250 completed pregnancies [10%, 95% CI = 7%–14%]). Birth defects were reported in 15% (95% CI = 8%–26%) of fetuses/infants of completed pregnancies with confirmed Zika virus infection in the first trimester. Among 895 liveborn infants from pregnancies with possible recent Zika virus infection, postnatal neuroimaging was reported for 221 (25%), and Zika virus testing of at least one infant specimen was reported for 585 (65%).

​Conclusions and Implications for Public Health Practice: These findings highlight why pregnant women should avoid Zika virus exposure. Because the full clinical spectrum of congenital Zika virus infection is not yet known, all infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy should receive postnatal neuroimaging and Zika virus testing in addition to a comprehensive newborn physical exam and hearing screen. Identification and follow-up care of infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with possible congenital Zika virus infection can ensure that appropriate clinical services are available.

Pregnant women infected with Zika risk giving birth to babies with an abnormally small head and brain. Credit: Flickr, bra_j
​

Zika is spread mostly by the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). There is no vaccine for Zika virus disease yet, which causes symptoms like mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise, or headache. The symptoms subside after 3-7 days but the biggest threat Zika possess is to pregnant women. It’s well established now that pregnant women infected with Zika risk giving birth to babies with microcephaly, a condition that causes babies to be born with abnormally small heads and brains, and Guillain-Barré syndrome.

“Zika virus can be scary and potentially devastating to families. Zika continues to be a threat to pregnant women across the U.S.,” said CDC Acting Director Anne Schuchat, M.D. “With warm weather and a new mosquito season approaching, prevention is crucial to protect the health of mothers and babies. Healthcare providers can play a key role in prevention efforts.”

The CDC report confirms previous studies which found women infected in the first trimester of their pregnancy are the most vulnerable. Some 15% of American women known to be infected with Zika during their first trimester had babies with birth defects. Overall, 10% of infected pregnant American women gave birth to babies with brain damage or other birth defects, so getting infected later in pregnancy can also be risky.

In total, the report covered 1,297 pregnancies which were tracked from Jan. 15 through Dec. 27, 2017. Of these pregnancies, 972 were confirmed to be Zika infected by lab evidence, which resulted in 895 live births and 77 losses (abortions, miscarriages, stillbirths).  Every 50 state and Washington, D.C, had at least once case of Zika-infected pregnancy.

Overall, 51 babies were born with birth defects. For the 250 cases or so where the presence of the Zika virus was confirmed, 24 pregnancies or 10 percent resulted in birth defects, most of which involved microcephaly. In eight cases, the damage included other brain malformations and dysfunctions in the central nervous system.

The report comes with a couple of caveats. Only 25 percent of the babies included in the study had their brains scanned, despite the CDC’s recommendation that all babies born to women with potential Zika infections should have their brains scanned. This limitation means we’re likely underestimating the birth defects that follow Zika in pregnancy. For instance, some babies that look fine at birth, i.e. with a normally sized head, might later be diagnosed with some congenital Zika syndrome.
​
“CDC recommends that pregnant women avoid travel to areas with risk of Zika and unprotected sex with a partner who has traveled to an area with Zika to prevent Zika-related birth defects in their babies,” said Peggy Honein, Ph.D., the Zika Response’s Pregnancy and Birth Defects Task Force co-lead. “CDC continues to work closely with health departments on the U.S. Zika Pregnancy Registry to follow up infants with possible congenital Zika virus infection and better understand the full range of disabilities that can result from this infection.”

​Key findings from the CDC's report

• Forty-four states reported pregnant women with evidence of Zika in 2016.
  • Most of these women acquired Zika virus infection during travel to an area with Zika.
• Nearly 1,300 pregnant women with evidence of possible Zika infection were reported to the U.S. Zika Pregnancy Registry.
  • Of the 1,000 pregnancies that were completed by the end of the year, more than 50 had Zika-related birth defects.
• Among pregnant women with confirmed Zika infection, about 1 in 10 had a fetus or baby with birth defects.
  • Confirmed infections in the first trimester posed the highest risk – with about 15% having Zika-related birth defects.
• About 1 in 3 babies with possible congenital Zika infection had no report of Zika testing at birth.
• Only 1 in 4 babies with possible congenital Zika infection were reported to have received brain imaging after birth.

 
Source:  ZME Science and CDC