July World Hepatitis Day

Transcription

1 July World Hepatitis Day A note from the author Happy July NCP friends! This month, we are going to focus on World Hepatitis Day, which falls on Friday, July Recently, I have seen many commercials about Hepatitis, specifically one aimed at the baby boomer generation, indicating that there are many people suspected to be undiagnosed with Hepatitis C. As a result of these public service announcements, I wanted to utilize the NCP Health Ministry to provide a little more information about the various types of this viral disease and, hopefully, help aid in a better understanding of why patients with Hepatitis need to seek medical diagnosis and treatment. What is World Hepatitis Day? World Hepatitis Day is July 28 th, 2017 and is an opportunity to highlight the global burden of this disease, CDC s efforts to combat viral hepatitis around the world, and what actions individuals can take. Also, World Hepatitis Day is an opportunity to add momentum to all efforts to implement the WHO's (World Health Organization) first global health sector strategy on viral hepatitis for and help Member States achieve the final goal - to eliminate hepatitis. Activities and awareness around World Hepatitis Day are designed to: Build and leverage political engagement following official endorsement of the Global Health Sector Strategy on viral hepatitis at the World Health Assembly 2016.

2 Showcase emerging national responses to hepatitis in heavy burden countries. Encourage actions and engagement by individuals, partners and the public. Highlight the need for a greater global response as outlined in the WHO's Global hepatitis report of The CDC s involvement in World Hepatitis Day The vision of CDC is to eliminate viral hepatitis in the United States and worldwide. CDC s recently released five-year strategic plan is organized around four key elements, one of which is Act globally to prevent, detect, and control viral hepatitis. CDC has been re-designated as a Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Center for Reference and Research on Viral Hepatitis. These WHO Collaborating Centers work to implement WHO s Global Hepatitis Strategy priority activities, serving as a reference laboratory, and providing technical assistance for the development of viral hepatitis guidelines and policies. CDC also assists countries experiencing a high burden of viral hepatitis. In recent years, these countries have included China, Egypt, Georgia, India, Pakistan, and Vietnam. Our international work is helping to reduce the disease burden for travelers and people migrating to the United States, while identifying best practices that may serve as models for other countries, including the United States.

3 World Health Organization s (WHO) involvement in World Hepatitis Day In support of the "Eliminate hepatitis" campaign, WHO will release new information on national responses in 28 countries with the heaviest burden. 11 countries which carry almost 50% of the global burden of chronic hepatitis: Brazil, China, Egypt, India, Indonesia, Mongolia, Myanmar, Nigeria, Pakistan, Uganda, Viet Nam. 17 countries that also have high prevalence and together with the above, account for 70% of the global burden: Cambodia, Cameroon, Colombia, Ethiopia, Georgia, Kyrgyzstan, Morocco, Nepal, Peru, Philippines, Sierra Leone, South Africa, Tanzania, Thailand, Ukraine, Uzbekistan, Zimbabwe. Why is World Hepatitis Day Important? Viral hepatitis is one of the leading causes of death globally, accounting for 1.34 million deaths per year that s as many as HIV/AIDS, tuberculosis or malaria. Together, hepatitis B virus and hepatitis C cause 80% of liver cancer cases in the world.

4 Viral hepatitis is not found in one location nor amongst one set of people; it is a truly global epidemic that can affect millions of people without them even being aware. Currently, 90% of people living with hepatitis B and 80% living with hepatitis C are not aware of their status. This can result in the real possibility of developing fatal liver disease at some point in their lives and in some cases, unknowingly transmitting the infection to others. With the availability of effective vaccines and treatments for hepatitis B and a cure for hepatitis C, the elimination of viral hepatitis is achievable, but greater awareness and understanding of the disease and the risks is a must, as is access to cheaper diagnostics and treatment. With the inclusion of viral hepatitis in the Sustainable Development Goals (SDGs) and the recent adoption of the world s first global hepatitis strategy, we are at a pivotal moment. Now more than ever political commitment is needed. Without urgent action, deaths will continue to rise and the epidemic will continue to grow. World Hepatitis Day presents an ideal opportunity: an opportunity to join together and raise the profile of viral hepatitis among the public, the world s media and on the global health agenda. World Hepatitis Day Key Messages The World Health Organization (WHO) released the following Key Messages for World Hepatitis Day 2017: 1. Viral hepatitis is a major global health problem and needs an urgent response. There were approximately 325 million people living with chronic hepatitis at the end of Globally, an estimated 257 million people were living with hepatitis B (HBV) infection, and 71 million people were living with hepatitis C (HCV) infection in 2015.

5 2. Very few of those infected accessed testing and treatment, especially in lowand middle-income countries. By the end of 2015, only 9% of HBV-infected people and 20% of HCV-infected people had been tested and diagnosed. Of those diagnosed with HBV infection, 8% (or 1.7 million people) were on treatment, while 7% of those diagnosed with HCV infection (or 1.1 million people) had started treatment in The global targets for 2030 are: 90% of people with HBV and HCV infections tested and 80% of eligible patients are reached with treatment. 3. Viral hepatitis caused 1.34 million deaths in comparable with TB deaths and exceeding deaths from HIV. Hepatitis deaths are increasing.

6 4. New hepatitis infections continue to occur, mostly hepatitis C. The number of children under five living with chronic HBV infection was reduced to 1.3% in 2015 (from 4.7% before vaccines were introduced). Hepatitis B vaccine is preventing approximately 4.5 million infections per year in children. However, 1.75 million adults were newly infected with HCV in 2015, largely due to injecting drug use and due to unsafe injections in health care settings in certain countries. 5. Achieving the 2030 elimination goal is not overly ambitious; reports from 28 high-burden countries give cause for optimism. On World Hepatitis Day 2017, WHO is publishing 28 country profiles which show that, despite many challenges, the global effort to eliminate hepatitis is gaining ground. However, major obstacles still remain. What is Viral Hepatitis? Hepatitis refers to an inflammatory condition of the liver. It s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue. Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including: bile production, which is essential to digestion filtering of toxins from your body excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs breakdown of carbohydrates, fats, and proteins activation of enzymes, which are specialized proteins essential to body functions storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K) synthesis of blood proteins, such as albumin synthesis of clotting factors

7 According to the Centers for Disease Control and Prevention (CDC), approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don t even know that they have hepatitis. Treatment options vary depending on which type of hepatitis you have. You can prevent some forms of hepatitis through immunizations and lifestyle precautions. Viral hepatitis a group of infectious diseases known as hepatitis A, B, C, D, and E- affects almost 400 million people worldwide, causing both acute (short-term) and chronic (long-term) liver disease and killing more than 1.4 million people every year. In 2013, viral hepatitis was the seventh leading cause of death worldwide, compared with the tenth in 1990, and caused more deaths than AIDS, tuberculosis, and even road injuries. The Dangers of Hepatitis Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for: chronic liver disease cirrhosis

8 liver cancer When your liver stops functioning normally, liver failure can occur. Complications of liver failure include: bleeding disorders a buildup of fluid in your abdomen, known as ascites increased blood pressure in portal veins that enter your liver, known as portal hypertension kidney failure hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function hepatocellular carcinoma, which is a form of liver cancer death People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.

9 How do you prevent Hepatitis? Hygiene Practicing good hygiene is one key way to avoid contracting hepatitis A and E. If you re traveling to a developing country, you should avoid: local water ice raw or undercooked shellfish and oysters raw fruit and vegetables Hepatitis B, C, and D contracted through contaminated blood can be prevented by: not sharing drug needles not sharing razors not using someone else s toothbrush not touching spilled blood Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection. Vaccines The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C. A vaccination for hepatitis E exists in China, but it isn t available in the United States. What are the different types of Hepatitis? 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.

10 While hepatitis B and hepatitis C cause the greatest global burden of disease, hepatitis A, hepatitis D, and hepatitis E are also global health concerns. Hepatitis A is primarily spread when someone who has never been infected with hepatitis A and is not vaccinated, ingests food or water that is contaminated with the feces of an infected person or has direct 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. o Transmission: Hepatitis A is spread mainly through eating food or drinking water that has been contaminated by the faeces of an infected person. It can also be spread by eating raw shellfish that have come from water contaminated by sewage. o Prevention: There is a vaccination for hepatitis A. Treatment within a few weeks of exposure to the virus can also bring short term immunity. You can reduce the risk of exposure by practicing good hygiene and sanitation, and avoiding drinking water that has come from a potentially unsafe source. The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine. o Treatment: As hepatitis A only causes acute hepatitis, the body is often able to clear the infection itself within a few weeks. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor s orders for hydration and nutrition. However, hepatitis A infections can sometimes cause further complications. Hepatitis B is spread through contact with blood or other body fluids of an infected person, including at birth from a mother to her baby and through sexual contact. 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. People who are

11 chronically infected can develop liver cirrhosis or even liver cancer. Hepatitis B is most common in sub-saharan Africa and east Asia, where between 5 10% of the adult population is chronically infected. Rates of chronic hepatitis B are also high in the Amazon region of South America, the southern parts of eastern and central Europe, the Middle East and the Indian subcontinent. Many people with chronic hepatitis B were infected at birth or during early childhood. Getting the hepatitis B vaccine is the most effective way to prevent hepatitis B virus infection. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth. In many parts of the world, widespread infant vaccination programs have led to dramatic declines of new hepatitis B cases. o Transmission: Hepatitis B is transmitted through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. It can be passed on from mother to child during childbirth. o Prevention: There is a vaccination that can prevent infection. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel. If you have not been vaccinated, to reduce chances of exposure it is best to use condoms, and to avoid sharing needles or items such as toothbrushes, razors or nail scissors with an infected person. It is also wise to avoid getting tattoos or body piercings from unlicensed facilities. o Treatment: Acute hepatitis B doesn t require specific treatment. Chronic hepatitis B is treated with antiviral medications. Drugs such as alpha interferon and peginterferon and a variety of antiviral drugs are available which slow the replication of the virus and occasionally result in its clearance. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment. Children born to mothers infected with hepatitis B should also be vaccinated within 12 hours of birth, as this can prevent an infection that will most likely progress to chronic hepatitis B.

12 Hepatitis C is spread through contact with blood of an infected person. Hepatitis C is common in many countries in the world; in much of Asia and Africa, most infections are caused by unsafe medical injections and other medical procedures. Hepatitis C related to injecting drug use occurs throughout the world; an estimated 67% of people who inject drugs having been infected with the hepatitis C virus. Mother-to-child transmission of hepatitis C is also possible. Hepatitis C, like hepatitis B, can also 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. Antiviral medicines can cure approximately 90% of people with hepatitis C, thereby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low. There is currently no vaccine for hepatitis C but research in this area is ongoing. o o o Transmission: Hepatitis C is mainly spread through blood-to-blood contact. In rare cases it can be transmitted through certain sexual practices and during childbirth. Prevention: There is no vaccination for hepatitis C. It is therefore necessary to reduce risk of exposure, by avoiding sharing needles and other items such as toothbrushes, razors or nail scissors with an infected person. It is also wise to avoid getting tattoos or body piercings from unlicensed facilities. Treatment: Antiviral medications are used to treat both acute and chronic forms of hepatitis C. Treatment for chronic hepatitis C aims to eradicate the virus. It often involves a combination of pegylated interferon and ribavirin, and there is increasing use of potent direct acting antiviral drugs, with and without interferon. People with different genotypes respond differently to treatment, some more successfully than others. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment. People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

13 *** The Hepatitis C virus is considered cured if the virus is not detected in your blood when measured with a blood test 3 months after treatment is completed. This is called a sustained virologic response (SVR) and data suggest that you will stay virus free indefinitely. Try to keep yourself as healthy as possible, keep your medical appointments and get regular checkups. Remember that you could become re-infected if you expose yourself to high-risk situations such as injection drug use, and so do everything possible to avoid these situations. Speak with a substance abuse counselor if needed. Hepatitis D is passed through contact with infected blood. It 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. o o o Transmission: Hepatitis D is spread through contact with infected blood. Prevention: Hepatitis D is only found in people who are already infected with the hepatitis B virus. People not already infected with hepatitis B, should get the hepatitis B vaccination. To reduce exposure, avoid sharing needles and other items such as toothbrushes, razors or nail scissors with an infected person. It is also wise to avoid getting tattoos or body piercings from unlicensed facilities. Treatment: No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people. Conditions may improve with administration of a- interferon, however no effective antiviral therapy is currently available for hepatitis D. Hepatitis E 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

14 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. o Transmission: Hepatitis E is mainly transmitted through eating food or drinking water that has been contaminated by the faeces of an infected person. It can also be spread by eating raw shellfish that have come from water contaminated by sewage. o Prevention: Currently there is a vaccine to prevent hepatitis E, but it is not widely available. You can reduce the risk of exposure by practicing good hygiene and sanitation, and avoiding drinking water that has come from a potentially unsafe source. o Treatment: Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care. Do you need to be tested or vaccinated for hepatitis? CDC and DVH are continuing to lay the foundation for the elimination of viral hepatitis as a public health threat, both domestically and abroad. Hepatitis A, hepatitis B, and hepatitis C are the most common types of viral hepatitis in the United States. To see if you need to be tested and/or vaccinated for hepatitis A, B, or C, take CDC s online Hepatitis Risk Assessment, which is based on U.S. recommendations. Resources