the global burden of hepatitis c dr daniel lavanchy world health organization (who) geneva,...
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The Global Burden of Hepatitis C
Dr Daniel LavanchyWorld Health Organization (WHO)
Geneva, Switzerland
3rd Paris Hepatitis Conference
Global Burden of Disease For centuries, mankind helpless against infectious diseases Germ theory & identification of microbes as causative agents led to the
development of vaccines and antimicrobials Optimists at the end of the 19th century predicted eradication of
infectious diseases 1950s, complacency set in with widespread use of penicillin,
development of polio vaccines and discovery of drugs for tuberculosis 1967, US Surgeon General stated that “the war against infectious
diseases has been won” 1981, Richard Krause, director US NIAlD warned that microbial
diversity and evolutionary vigor were still forces threatening mankind
Global Burden of DiseaseAbout 15 million (>25%) of 57 million annual
deaths worldwide are estimated to be related directly to infectious diseases
This figure does not include the deaths that occur as a consequence of complications associated with chronic infections, such as liver failure and hepatocellular carcinoma in people infected with hepatitis B or C viruses
End-stage Liver Disease
Cirrhosis > 783'000 deaths / year
Liver cancer > 619'000 deaths / year
~1 of every 40 death worldwideBut no good breakdown according to aetiology
Hepatitis C Global BurdenHepatitis C Global Burden
WHO estimates:
2.3 - 4.7 millions new infections/year
300'000 deaths annually
130-170 million persons chronically infected
Country HCV prevalence
Deaths
per year* Mortality* per
100,000
Bangladesh 2.4 11,500 9.6Bolivia 16.3 4,900 65.1Brazil 2.6 16,700 10.4Canada 0.15 180 1.7Chad 4.8 1250 19.2China 4.07 231,600 18.8Egypt 18.1 45,800 72.5Ethiopia 0.84 1,900 3.1France 1.15 2,600 4.6Germany 0.12 390 0.48India 1.85 69,900 7.4Indonesia 2.1 16,900 8.04Italy 0.48 1100 1.9Japan 2.3 11,500 9.2*Estimate based on an annual death rate among HCV-positive patients of 0.4%
Impact of HCCImpact of HCC
US national spending each year on HCC – $ 32,907 / case
– total annual burden $ 454.9 million – (Lang et al. 2009)
Interventions to reduce the prevalence of HCC have the potential to yield sizable economic benefits
Screening and treatment programs aimed at reducing viral hepatitis-related morbidity will reduce hospitalization rates
Institute for Public Health, Medical Decision Making and Health Technology Assessment 9
European region
• Hepatitis C is a major public health problem in the WHO European region, costing twice as many lives and about as many ‘healthy’ live years as HIV/AIDS.
• Burden of disease caused by advanced disease highlights the potential benefit of antiviral treatment.
• Varying transplantation and mortality rates suggest inequality of health care services across Europe.
• Most importantly, the lack of data indicates that hepatitis C still is a neglected disease.
• What is needed are PUBLIC AWARENESS, coordinated action plans, more and better data.
Global Burden: BasicsGlobal Burden: Basics
Global data:
Little more has been done at country level since first WHO estimates in 1997
38 different HCV surveillance systems in 27 EU countries (Rantala 2008)
Anti-HCV > RNA positive confirmed in 40-90%– EMCCDA. Annual report 2006
Predicted HCV Related DeathsPredicted HCV Related Deaths
Predictions are difficult,
Particularly about the future
Yogi Berra
Prevalence data still not available in many countries– prevalence studies of the general population needed for an accurate estimate
of the rate of infection and the number of individuals chronically infected
Detection of outbreaks of HCV infection difficult
Incidence impossible to measure
Under-reporting (20-50%)
Long-term disease burden outcome not yet known
Heterogeneity in availability/quality of data
GlobalGlobal Hepatitis C EpidemicHepatitis C Epidemic
SummarySummary
Lack of disease burden data Lack of awareness Political commitment difficult
– Holistic strategy for prevention, control & management of hepatitis A, B, & C (E)
Set clear, quantifiable targets for
– reducing incidence and prevalence– reducing morbidity & mortality
Global Public Health GoalsGlobal Public Health Goals
Public recognition as important public health issue
Government lead for a national strategy – for awareness raising, screening, diagnosis, referral and treatment
– If public health does not lead, who should lead ?
Google ? Industry? Doctors? Rock stars? Media?
Coordinated approach globally– Globally involve advocacy groups, professionals and scientific societies
ConclusionsConclusions Heavy global burden – assessment behind schedule
– no global data
– few good national estimates
– WHO work in progress
Standardized approach is essential
Implementation of comprehensive national programs still needed in 2008 = global political agenda with clear targets
Research is necessary to define best practices
Global team effort necessary
Hepatitis C VaccineHepatitis C Vaccine
Investigational E1E2/MF59 vaccine (Novartis)
Correlates of protection are complex
Future development ? • Urgent !