Combatting hepatitis worldwide

By Kathleen Mell, Marquette County Health Department

World Hepatitis Day takes place every year on July 28. It is a day that brings the world together to raise awareness of the global burden of viral hepatitis and to influence real change. Officially endorsed by the World Health Organization, World Hepatitis Day unites health organizations, governments, medical professionals, industry and the public to highlight the challenges of viral hepatitis.

Viral hepatitis is one of the leading causes of death worldwide, accounting for 1.34 million deaths per year. Together Hepatitis B and Hepatitis C cause 80 percent of liver cancer cases in the world.

Viral hepatitis is a global epidemic that can affect a million people without their realization of its impact. Currently, 90 percent of people who are living with Hepatitis B and 80 percent who are living with Hepatitis C are not aware of their condition. These individuals are more vulnerable to fatal liver cancer and the unknowing transmission of hepatitis to other people. The availability of effective vaccines and treatments for Hepatitis B and for Hepatitis C make the elimination of viral hepatitis an obtainable goal. Awareness and understanding of the disease, and its risks, are essential, along with access to care and affordable treatment.

At the 69th World Health Assembly in Geneva, 194 governments adopted the WHO’s Global Strategy on viral hepatitis. One of the primary goals of the strategy is to eliminate Hepatitis B and C in the next 13 years. A step toward this goal is the campaign NOhep, the first ever-global movement to eliminate viral hepatitis by 2030.

The World Hepatitis Day campaign focus is not just the elimination of viral hepatitis as a public health goal – but also as an individual goal for millions of men, women, and children across the world.

We must raise awareness and understanding of the disease and the risk in our state.

“Hepatitis” is an inflammation of the liver and also refers to a group of viruses that infect the liver. The most common types of viral hepatitis are Hepatitis A, Hepatitis B and Hepatitis C. These viruses can produce an acute illness characterized by nausea, malaise, abdominal pain, and jaundice, although many of these acute infections show little to no symptoms of the disease. Hepatitis A is transmitted from person to person via the ingestion of food and water contaminated with human waste. Hepatitis B and C are both blood-borne infections. Many people infected with Hepatitis B or Hepatitis C are unaware that they are infected. Unlike Hepatitis A, the viruses of Hepatitis B and Hepatitis C can produce chronic infections that often remain clinically silent for decades while increasing the risk for liver disease and cancer. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation in the United States. An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. In 2015, there were 1,137 new cases of Hepatitis B and 7,917 cases of Hepatitis C in Michigan.

Hepatitis A is a vaccine-preventable disease. The vaccine is recommended as part of the routine childhood vaccination schedule; most adults have not been vaccinated and may be susceptible to the Hepatitis A virus.

From August 1, 2016, to March 21, 107 cases of lab-confirmed Hepatitis A have been reported to public health authorities in Southeast Michigan. This represents an eightfold increase during the same time last year. Ages of the cases range from 22 to 86 years, with an average age of 45 years. The majority of the cases have been male. A total of 85 percent of the cases have been hospitalized, with two resulting in death.

Hepatitis B Virus (HBV) is transmitted through contact with the blood or body fluids of an infected person, most often through sharing infected injection drug use equipment, sexual contact with an infected person, or from an infected mother to her newborn during childbirth. Transmission of HBV also can occur among persons who have prolonged contact with someone who is HBV-infected (e.g., household contacts). Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain. In some people, the HBV can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer. Effective Hepatitis B vaccines have been available in the United States since 1981 and the CDC recommends vaccination of all infants at birth. Several oral drugs are now available, leading to viral suppression in 90 percent of patients taking one of these new oral medications.

Hepatitis C Virus (HCV) is transmitted primarily through exposure to infected blood, which can result from sharing infected injection drug use equipment, needle stick injuries involving contaminated blood, receipt of blood or blood products before the availability of a standard screening test in 1992 and inadequate infection control in health care settings. Sneezing, coughing, or kissing does not spread HCV. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

With an estimated 3.2 million chronically infected persons nationwide, HCV infection is the most common blood-borne infection in the United States. Worldwide, about 150 million people are chronically infected with HCV, and more than 350,000 people die every year from Hepatitis C-related liver diseases. Since no vaccine is available for preventing Hepatitis C infection, other prevention activities, such as not sharing infected injection drug equipment and consistently implementing and practicing infection control in health care settings, are vital. Access to care and treatment is critical to improving health outcomes for persons found to be infected with HCV. This accessibility is particularly important in light of the major advancements that have been made in treatment of Hepatitis C.

The number of cases of chronic Hepatitis C among persons aged 18 to 29 years has increased over 302 percent in Michigan from 2005 to 2015. Injection drug use in 18 to 29 year olds was reported in 86.7 percent of Hepatitis C patients.

Viral hepatitis has affected the overall incidence rate for liver cancer in Michigan, which has increased by 33 percent between 2004 and 2013. The overall liver cancer mortality rate has increased by 39 percent between 2004 and 2014 in Michigan. Deaths due to chronic Hepatitis C alone increased by 62 percent between 2004 and 2014. There were 170 deaths attributed to chronic Hepatitis C in Michigan in 2014.

It is clear from the above statistics that Michigan and the Upper Peninsula can save lives, and benefit from the World Hepatitis Day challenge to eliminate viral hepatitis by 2030.

Awareness, knowledge of the risk, knowing your status and discussing viral hepatitis with your primary care provider is the first step we need to take. Our individual efforts to accomplish this will move the world closer towards the elimination of viral hepatitis by 2030. Take the pledge NOhep!

Contact the Marquette County Health Department or visit www.worldhepatitisday.org, www.michigan.org/hepatitis or www.NOhep.org for further information.

Editor’s note: Mell is a Michigan Department of Health and Human Services Immunization Field Representative. She is also a registered nurse and has a bachelor of science degree in nursing.

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