World Hepatitis Day 2024

Hepatitis is a general term used to address an inflammation of the liver, one caused by various viral and non-viral causes. World Hepatitis Day, observed on the 28th of July is a Day dedicated to bringing attention to and raise awareness of viral hepatitis, a disease linked to severe liver diseases and even cancer.

Hepatitis, given its overarching term, can be cause by a variety of causes, the ones responsible for non-viral hepatitis tend to be non-infectious agents. These include autoimmune diseases, excessive alcohol consumption, or certain medications or toxins.

The aim of this day is to encourage action and address all types of hepatitis, however, the focus is primarily on viral hepatitis, of which, the five most common strains are called types A,B,C,D, and E.

Of these main strands, hepatitis A (HAV) is commonly transmitted by ingestion of faecal matter, and hepatitis E (HEV) by consumption of contaminated food and water, making both easier to prevent with the implementation of sanitation and hygienic facilities; additionally, both also tend to be milder, resolve quicker and without specific treatments, and in some cases without noticeably symptoms.

Hepatitis B (HBV) is primarily transmitted through contact with infected blood, semen, or other bodily fluids, although the virus can also be transmitted from the mother to the baby. This type can lead to more serious symptoms such as liver cirrhosis and cancer and is prevented via vaccination or preventing high risk behaviours like unprotected sex or sharing needles.

Hepatitis C (HCV), transmitted through blood contact via sharing needles or unsafe healthcare practices (for example accidental needlestick injuries or unsuitable sterilisation of medical equipment) is another strain that also leads to long-term liver damage, liver cirrhosis, or even liver cancer. While there is no vaccine for this strain of hepatitis the treatment has been developing and improving over the past few years, although, regular monitoring both during and after treatment is important to monitor the treatment response.

Lastly, Hepatitis D (HDV), unlike the other viral types of hepatitis cannot cause infections on its own, instead, it only occurs in patients already infected with hepatitis B specifically. Like HBV this strain is passed on through blood and bodily fluids, or from the mother during childbirth, however, due to the link with hepatitis B, it means treatment is focused on treating HBV as there are no specific medications for HDV.

Out of these types, one can see that both HBV and HBC strains are the ones with higher risk as well as cause more severe results, primarily liver cirrhosis and liver cancer. Of the two, countries most affected by hepatitis B are located in Sub-Saharan Africa, as well as Central, East, and Southeast Asia and Melanesia, whereas those most affected by hepatitis C are in West and Central Africa as well as North and Central Asia. When looking at countries individually, Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam, collectively shoulder nearly sixty percent of the global burden of both hepatitis B and C.

These are primarily areas in the Global South, which naturally makes these strains more difficult to prevent due to less development and sanitation in these regions. To make matters worse, this is an issue that is progressively getting worse, deaths from viral hepatitis are increasing worldwide, from 1.1 million in 2019 to 1.3 million in 2022, of which, 83% caused by hepatitis B and 17% by hepatitis C. Globally, there is an enormous amount of undiagnosed people, nearly 220 million with hepatitis B and 36 million with hepatitis C with symptoms becoming noticeable during the more advanced stages of liver disease. This becomes especially troubling considering hepatitis B can be prevented with a vaccine, even though this strain can be transmitted from mother during childbirth, if the mother is vaccinated or the child at birth this statistic can be reduced.

Unfortunately, while there are goals that we are striving for globally, there are still many problems we face. The most notable ones: Services providing such tools often out of reach of those in need and only found in centralised or specialised hospitals; Rapid diagnostics tests for viral hepatitis which cost less than US$2 are too expensive for those living in the less developed regions of the world, with many people facing out-of-pocket expenses; and many countries that require viral hepatitis medicines, despite the availability of affordable options, many countries still end up overpaying for them.

In order to address the price barrier of rapid diagnostics tests, the WHO has prequalified the first self-test for hepatitis C in order to encourage testing despite the stigma and discrimination. Moreover, individuals within the country are aiding in this fight; in the case of Vietnam, one of eleven countries that bear half of the world’s viral hepatitis burden, there are collaborations between medical professionals and institutes from other countries trying to aid and help develop an infrastructure, and help train local physicians and develop training programs. It seems like there is a long road ahead with the battle against hepatitis, however, despite the problems we face in fighting this disease, with co-operation and a joint effort, there is a reason to be optimistic.