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The first official WHO World Hepatitis Day, 28 July 2011: WHO (World Health Organization: About 130-170 million people are chronically infected with hepatitis C virus, and more than 350 000 people die from hepatitis C-related liver diseases each year. 130 million with Hep C and Hep B in SE Asia.
  The first official WHO World Hepatitis Day, 28 July 2011, is marked to increase the awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as:
· strengthening prevention, screening and control of viral hepatitis and its related diseases;
· increasing hepatitis B vaccine coverage and integration into national immunization programmes; and
· coordinating a global response to hepatitis.
Viral Hepatitis, a major public health threat
Monday, Jul 25, 2011 Kuensel Online/Asia News Network
Viral hepatitis kills more people than any other communicable disease in the South-East Asia Region. In the next 10 years, over five million people in the region is projected to die from this disease and its consequences.
Today, more than 130 million people in South-East Asia alone, carry the hepatitis B or C virus, even though they may appear healthy. It usually strikes people at their most productive age.
The hepatitis B virus is 50 to 100 times more infectious than HIV, and just as lethal. Hepatitis E results in 2700 still births every year. For such a major public health threat, hepatitis has a low profile, among policy-makers and the public.
Recognising hepatitis as a threat to public health, the World Health Assembly passed a resolution to prevent and control the disease last year. The World Health Organization has decided to observe July 28 this year as the world's first ever World Hepatitis Day.
It is thus an opportune time to ask if we are doing enough to protect ourselves from this disease?
Many people recognise the symptoms of jaundice by the yellowing of the eyes and skin. Yet, jaundice is only the face of the disease and the common symptom for any of the four common types of viral hepatitis. These are easily contracted from drinking water to casual contact to sexual intercourse. Even then, not every infected person shows symptoms.
WHO is developing guidelines, strategies and tools for surveillance, prevention and control of this disease. Prevention and focussing on the source and mode of spread of the virus, is crucial to control this disease.
Chronic hepatitis B and C are among the leading causes of preventable deaths in 11 countries of the region. About 100 million hepatitis B carriers, and 30 million hepatitis C carriers, live in South-East Asia.
However, about 60 per cent of the infected are unaware of their status until the disease manifests as cirrhosis or liver cancer - an aggressive cancer without a cure. Hepatitis C, in particular, has no vaccine or effective cure. Those who undergo blood transfusion, as well as injecting drug users, are at risk.
Due to lack of knowledge and resources among healthcare workers, many providers in the region do not comply with WHO's and national guidelines and recommendations for hepatitis B and C screening, prevention, treatment and follow-up services. A patient requiring transfusion may receive blood that has been screened for HIV, but not for hepatitis B or C.
The hepatitis B vaccine can go a long way to prevent hepatitis B. It is more than 95 per cent effective in preventing infections and their chronic consequences, and is the first vaccine that protects against a major human cancer. In WHO's South-Asia Region, more than 130 million infants have received the three required doses of hepatitis B vaccine.
Hepatitis infection is also linked to personal hygiene, sanitation and urban health - hepatitis A and E are both commonly spread through eating or drinking contaminated food or water. Pregnant women are at high risk of hepatitis E. Hepatitis E acquired during pregnancy is also associated with prematurity, low birth weight and an increased risk of perinatal mortality.
In countries of WHO's South-East Asia Region, more than 6.5 million people are infected with hepatitis E annually accounting for half the cases worldwide, leading to an estimated 160 000 deaths.
Hepatitis E outbreaks often occur in urban areas when leaky underground water pipes are contaminated with sewage. In developing countries, with increasing population pressure and rapid urbanisation leading to people living in close, unsanitary conditions, such diseases are likely to increase rapidly.
So what can be done to prevent and control hepatitis?
To begin with, all countries, especially those urbanising rapidly, need to make hepatitis a health priority. Lives could be saved through simple preventive measures such as hand washing, eating cooked food and boiled water, using condoms and not sharing needles.
Countries need to make screening of all blood and blood products for hepatitis B and C mandatory. Governments should ensure that children are adequately immunised against hepatitis B. Healthcare workers, and the public, need to be educated on the risks and the surveillance system for hepatitis needs to be strengthened.
Unless we act now to create greater awareness among policymakers, healthcare workers, and the public, viral hepatitis will remain a major public health threat.
Dr Samlee Plianbangchang
Regional Director
WHO South-East Asia
Hepatitis C
Fact sheet N°164 June 2011
Key facts

· Hepatitis C is a liver disease caused by the hepatitis C virus (HCV).
· HCV infection sometimes results in an acute symtomatic illness. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong chronic condition that can lead to cirrhosis of the liver and liver cancer.
· HCV is transmitted through contact with the blood of an infected person.
· About 130-170 million people are chronically infected with hepatitis C virus, and more than 350 000 people die from hepatitis C-related liver diseases each year.
· HCV infection is curable using increasingly effective antivirals.
· Despite ongoing research, there is currently no vaccine to prevent hepatitis C virus infection.
Hepatitis C is a contagious liver disease that results from infection with hepatitis C virus (HCV). It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. HCV is usually spread when blood from a person infected with HCV enters the body of someone who is not infected. HCV is among the most common viruses that infect the liver.
It is estimated that 3-4 million people are infected with HCV each year. Some 130-170 million people are chronically infected with HCV and at risk of developing liver cirrhosis and/or liver cancer. More than 350 000 people die from HCV-related liver diseases each year.
HCV infection is found worldwide. Countries with high rates of chronic infection are Egypt (22%), Pakistan (4.8%) and China (3.2%). The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment.
The virus is most commonly transmitted through exposure to infectious blood such as through: receipt of contaminated blood transfusions, blood products, and organ transplants; injections given with contaminated syringes, needle-stick injuries in health-care settings; injection drug use; being born to an HCV-infected mother. It is less commonly transmitted through sex with an infected person and sharing of personal items contaminated with infectious blood.
Hepatitis C is not spread through breastmilk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Getting tested
Knowing one's infection status can prevent health problems that may result from HCV infection and prevent transmission to family and close contacts. Some countries recommend screening for individuals who may be at risk for infection.
These include:
· individuals who received blood, blood products or organs before screening for HCV was implemented or where screening was not yet widespread;
· current or former injecting drug users (even those who injected drugs once many years ago);
· patients on long-term hemodialysis;
· health-care workers;
· people living with HIV;
· individuals with abnormal liver tests or liver disease;
· infants born to infected mothers.
Primary prevention
No vaccine exists to prevent HCV infection, unlike those for hepatitis A and B virus. The risk of infection can be reduced by avoiding:
· unnecessary and unsafe injections;
· unsafe blood products;
· unsafe sharps waste collection and disposal;
· use of illicit drugs and sharing of injection equipment;
· unprotected sex with HCV-infected persons;
· sharing of sharp personal items that may be contaminated with infected blood;
· tattoos, piercings and acupuncture performed with contaminated equipment.
Secondary and tertiary prevention
If a person is infected with HCV, they should:
· receive education and counselling on options for care and treatement;
· be immunized with hepatitis A and B vaccine, to prevent co-infection from these hepatitis viruses, to protect their liver;
· get early and appropriate medical management including antiviral therapy if appropriate; and
· get regular monitoring for early diagnosis of liver disease.
Diagnosis of acute infection is often missed because the infected person has no symtoms. Common methods of antibody detection cannot differentiate between acute and chronic infection. The presence of antibodies against HCV (anti-HCV) indicates that a person is or has been infected. HCV recombinant immunoblot assay (RIBA) and HCV RNA testing are used to confirm the diagnosis of HCV infection.
Diagnosis of chronic infection diagnosis is made when anti-HCV is present for more than 6 months. Similar to acute infections, diagnosis should be confirmed with an additional test. Specialized tests are often used to evaluate patients for liver disease including cirrhosis and liver cancer.
Disease progression
Following initial infection, approximately 80% of people do not exhibit any symptoms. Those people who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain, and jaundice (yellowing of skin and the whites of the eyes). When a chronically-infected person develops symptoms, it may indicate advanced liver disease.
Statistically, 60-70% of chronically-infected persons develop chronic liver disease, 5-20% develop cirrhosis, and 1-5% die from cirrhosis or liver cancer.
Interferon and ribaviron-based therapy has been the mainstay of HCV treatment. Unfortunately, interferon is not widely available globally, is not always well tolerated, some genotypes respond better than others, and many people who take it do not finish their treatment. While HCV is generally considered to be a curable disease, for many persons this is not a reality. Fortunately, scientific advances and intense research and development have led to the development of many new oral antiviral drugs for HCV infection. The future seems to hold great promise for HCV specific oral drugs that will be more effective and better tolerated. Much still needs to be done to ensure that these advances l lead to greater access and treatment globally.
WHO response
The first official WHO World Hepatitis Day, 28 July 2011, is marked to increase the awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as:
· strengthening prevention, screening and control of viral hepatitis and its related diseases;
· increasing hepatitis B vaccine coverage and integration into national immunization programmes; and
· coordinating a global response to hepatitis.
Hepatitis B
Fact sheet N°204 Revised August 2008

Key facts
· Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
· The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
· About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
· About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
· The hepatitis B virus is 50 to 100 times more infectious than HIV.
· Hepatitis B virus is an important occupational hazard for health workers.
· Hepatitis B is preventable with a safe and effective vaccine.
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.
Worldwide, an estimated two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections.
A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer.
Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People can take several months to a year to recover from the symptoms. HBV can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.
Who is most at risk for chronic disease?
The likelihood that an HBV infection will become chronic depends upon the age at which a person becomes infected, with young children who become infected with HBV being the most likely to develop chronic infections. About 90% of infants infected during the first year of life develop chronic infections; 30% to 50% of children infected between one to four years of age develop chronic infections. About 25% of adults who become chronically infected during childhood die from HBV-related liver cancer or cirrhosis.
About 90% of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months.
Where is hepatitis B most common?
Hepatitis B is endemic in China and other parts of Asia. Most people in the region become infected with HBV during childhood. In these regions, 8% to 10% of the adult population are chronically infected. Liver cancer caused by HBV is among the first three causes of death from cancer in men, and a major cause of cancer in women. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and Indian sub-continent, an estimated 2% to 5% of the general population is chronically infected. Less than 1% of the population in western Europe and North American is chronically infected.
Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i.e. semen and vaginal fluid) of an infected person. Modes of transmission are the same for the human immunodeficiency virus (HIV), but HBV is 50 to 100 times more infectious Unlike HIV, HBV can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.
Common modes of transmission in developing countries are:
· perinatal (from mother to baby at birth)
· early childhood infections (inapparent infection through close interpersonal contact with infected household contacts)
· unsafe injections practices
· blood transfusions
· sexual contact
In many developed countries (e.g. those in western Europe and North America), patterns of transmission are different than those mentioned above. Today, the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use. HBV is a major infectious occupational hazard of health workers.
HBV is not spread by contaminated food or water, and cannot be spread casually in the workplace.
The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time.
There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries. Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.
Patients with cirrhosis are sometimes given liver transplants, with varying success.
All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.
The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).
The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.
All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:
· persons with high-risk sexual behaviour;
· partners and household contacts of HBV infected persons;
· injecting drug users;
· persons who frequently require blood or blood products;
· recipients of solid organ transplantation;
· those at occupational risk of HBV infection, including health care workers; and
· international travellers to countries with high rates of HBV.
The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.
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