Transcript The Global Burden of Hepatitis C

The Global Burden of Hepatitis C
Dr Daniel Lavanchy
World 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 Disease
Global Burden of Disease
 About 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 worldwide
But no good breakdown according to aetiology
Hepatitis 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
per year* Mortality* per
Deaths
Bangladesh
Bolivia
Brazil
Canada
Chad
China
Egypt
Ethiopia
France
Germany
India
Indonesia
Italy
Japan
2.4
16.3
2.6
0.15
4.8
4.07
18.1
0.84
1.15
0.12
1.85
2.1
0.48
2.3
100,000
11,500
4,900
16,700
180
1250
231,600
45,800
1,900
2,600
390
69,900
16,900
1100
11,500
*Estimate based on an annual death rate among HCV-positive patients of 0.4%
9.6
65.1
10.4
1.7
19.2
18.8
72.5
3.1
4.6
0.48
7.4
8.04
1.9
9.2
Impact 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
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.
Institute for Public Health, Medical Decision Making and Health Technology Assessment
9
Global 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
Hepatitis C Incidence
Forecasted cases of hepatitis C
for 2001–2040
Health care costs associated with
hepatitis C for 2001–2040
Predicted HCV Related Deaths
Predictions are difficult,
Particularly about the future
Yogi Berra
HCV Related Mortality USA
Wise, 2008
Global Hepatitis C Epidemic
 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
Summary
 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 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
Conclusions
 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 Vaccine

Investigational E1E2/MF59 vaccine
(Novartis)

Correlates of protection are complex

Future development ?
• Urgent !
Thank you
www.who.int
http://www.who.int/topics/hepatitis/en/