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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C
An estimated 130–170 million people live with chronic HCV infection worldwide, and an estimated 350,000 die of HCV-related liver disease each year (Perz et al., 2006). There are about 2.3–4.7 million new HCV infections each year from nosocomial transmission alone (Lavanchy, 2009). Unsafe mass immunization has led to exceedingly high HCV prevalence in some areas, such as Egypt, where 14–20% of the population has HCV antibodies (Frank et al., 2000; Lavanchy, 2008). In most populations in Africa, North America, South America, Europe, and Southeast Asia, the prevalence in the general population is less than 3% (Lavanchy, 2008).
HCV is efficiently transmitted via direct percutaneous exposure to infectious blood. Hepatitis C became a global epidemic in the 20th century as blood transfusions, hemodialysis, and the use of injection needles to administer licit and illicit drugs increased throughout the world (Drucker et al., 2001; Pybus et al., 2007). For example, the extremely high prevalence of HCV in Egypt is due to a schistosomiasis-eradication campaign that began in the 1960s, when more than 35 million injections were administered to about 6 million Egyptians (Deuffic-Burban et al., 2006; Frank et al., 2000; Lehman and Wilson, 2009). The identification of the virus in 1989 led to measures to reduce health-care–related exposure to HCV, particularly in industrialized nations. However, more than six billion unsafe injections are given worldwide each year (Hutin et al., 2003).
With the reduction in health-care–related exposures to HCV and the recent introduction of the practice of illicit-drug injection in new regions of the world, HCV infection through injection-drug use has become the major source of exposure to HCV worldwide. Explosive increases in HCV infection have occurred in regions of Asia and central and eastern Europe because of poor access to sterile injection equipment and lack of drug treatment. A recent meta-analysis reported that HCV prevalence was 84% in injection-drug users (IDUs) surveyed in the Guangxi region bordering the Golden Triangle in China (Xia et al., 2008). In that region, drug use is highly stigmatized, which reduces community support for prevention efforts and inhibits IDUs’ access to prevention services. Antiviral treatments for chronic HBV and HCV infections can effectively reduce the associated morbidity and mortality from liver disease. However, access to treatment is often limited by high costs of care and by the asymptomatic nature of chronic HBV and HCV infections. Therefore, many infected people are not identified in time to benefit from antiviral treatment.
Global eradication or elimination of new HBV infections is plausible because the infections can be prevented with the hepatitis B vaccine. No vaccine to prevent hepatitis C has been licensed. Given the limitations of the scope of the committee’s work, it did not assess global prevention and control efforts for hepatitis B and hepatitis C and did not consider the international effects of its recommendations.