Hepatitis c virus epidemiolgy
To ensure the maximum implementation of its vision, WHO has provided technical guidance and support to reduce disease transmission such as ensuring safer blood transfusion, disposable needles, etc. Hepatitis A vaccine should be available to susceptible individuals in low and intermediate endemic areas[ 71 ]. Birth dose vaccination of HBV is critical to prevent mother to child transmission as late vaccination is not fully effective in breaking mother-to-child transmission chain.
Coordination between vaccination and maternal health services should be established effectively[ 60 ]. Currently, a number of treatment options are available for HBV that will improve long-term survival. However, treatment is not accessible in many countries due to high cost[ 72 ]. More than people die from HCV infection every year[ 73 , 74 ].
Currently, there is no vaccine to protect individuals from HCV due to the peculiarity of the virus. However, traditional curative treatment is available based on genotyping of the virus, and safe blood transfusion strategies similar to that of HBV can be undertaken to prevent spread.
The traditional genotype-based therapies with interferon, has been shown to be moderately successful in the sustained elimination of the viral genome[ 76 ].
However, the introduction of pan-genotypic treatments for all genotypes of hepatitis C has been a major breakthrough in scientific research. Once the therapy is widely accessible to all infected patients, this will eventually decrease the burden of disease, economic burden on health care, with a subsequent decline in morbidity and mortality[ 69 ].
Currently, no specific recommended treatment for HDV is recommended[ 23 ]. There is one vaccine under development against HEV in China, which is yet to implemented routinely[ 76 ]. The viral hepatitis outbreaks can be controlled with comprehensive global action plans and collaborations. A number of models have been used for viral hepatitis management. WHO has a vision and its goal is to eliminate viral hepatitis worldwide as a major public health problem[ 69 - 74 ].
In this global strategy, five core interventions have been proposed and the targeted areas are vaccination plans for hepatitis B, A and E, prevention of vertical transmission of hepatitis B, injection and blood products safety, harm reduction and treatment[ 77 - 79 ].
Elimination of viral hepatitis requires strong national and international commitments. Comprehensive action plans for prevention, screening, diagnosis and treatment of viral hepatitis should be implemented through collaborations between government, health service providers and society[ 78 , 79 ].
This model for hepatitis C management was established in prison and provided advice on harm minimisation, diagnosis and treatment. HCV infected persons often face obstacles to access treatment such as not being aware of availability of modern therapies, high cost, fear and distrust of healthcare professionals.
Some studies suggested that nurse-led models provided a good opportunity for instituting intervention against transmission and spread of HCV but it was minimally successful in reducing HCV transmission among prisoners[ 79 - 81 ]. However, it has also been shown that professional care and specialist-managed treatment models for chronic HCV do result in improved treatment uptake and low disease burden[ 49 , 82 ].
People who recover successfully from the infection can work closely with multidisciplinary clinical care team to offer extensive viral hepatitis support, care and access to treatment specifically for those who have barriers to clinical care[ 70 ]. Major obstacles that hinder care among HCV infected intravenous drug users should be overcome by strategies such as on-site treatment, addiction management plan, multidisciplinary teams work, intensive model of care, directly peer observed treatment and group treatment[ 79 - 81 ].
It has been shown that combination of clinical and behavioral interventions can result in reduction of HCV among substance users[ 80 - 82 ]. The prevalence of HCV infection among intravenous recreational drug users remains high worldwide. Despite the availability of well-tolerated successful treatment, morbidity and mortality due to liver disease among people with HCV infection is still increasing. The Kirby Institute, The University of New South Wales Sydney and the International Network on Hepatitis in Substance Users have organised an expert roundtable panel to evaluate current issues and implemented future research priorities for the prevention and management of HCV among people who inject drugs.
International experts in drug and alcohol, infectious diseases, and hepatology have come together on one platform to identify the current scientific evidence, issues in research, and develop research priorities[ 79 ]. Providing outreach services is important in viral hepatitis management. One example includes mobile health clinics which are an innovative and flexible way to provide healthcare for chronic viral hepatitis patients.
They have been proven effective in giving the health screenings, initiating chronic disease management and providing immediate intervention when required. The mobile van clinic has been a novel approach for controlling viral hepatitis[ 75 ].
HCV is prevalent among the injecting drug users especially those in prison, the aboriginal population and people coming from culturally and linguistically diverse background.
These are the people who are disconnected from traditional health providers and have poor retention in care systems. To engage these people in the health care system and to provide the appropriate treatment requires innovative action plans[ 75 , 49 ]. The above-mentioned mobile outreach vans will bring the treatment services to these people and will also make it easier for them to access the health services particularly for those who have comorbid psychiatric and substance use disorders.
It will create a link between clinical and community-based settings and will remove geographic, socioeconomic and structural obstacles. Successful treatment of HCV infections will decrease the risk of chronicity of the disease and liver cancer, improve the quality of life and will also increase the survival rates[ 77 , 78 ].
The mobile outreach system will also help in reducing the transmission of disease by providing the early treatment, improved viral clearance and reduced risk behaviors[ 75 ]. Many cases of viral hepatitis occur among health workers due to accidental needle injuries.
Preventing work-related accidents in health organisations should be urgently reviewed. Prompt IgG treatment option should be in place as soon as exposure to virus is confirmed.
This treatment may stop the infection from developing. Patients exposed to viruses should undergo similar treatment. This prompt strategy could serve as an efficient therapeutic modality and prevent development of infection and minimise outbreaks. Although there has been some success with preventative strategies globally, still many hurdles need to be overcome if we are to reduce viral transmission significantly. WHO has published its technical report manual for the development and assessment of national viral hepatitis plans in [ 49 ].
This guidance could help to control viral hepatitis outbreaks. These actions need to be strengthened and reinforced in order to stop the outbreaks and provide a viral hepatitis-free future for the next generation. One of the important actions to be adopted to control outbreak is prompt immune serum treatment. WHO can include post-exposure prophylaxis in their global strategy which at first can be implemented in resource-rich settings and gradually adopted in developing and underdeveloped countries.
For global success in controlling viral hepatitis, international organisations can establish round tables to exchange ideas for action plans. There is no one single measure strong enough to curb viral hepatitis epidemics but having a global vision and implementing multiple strategies will go some way towards reducing global disease burden.
Conflict-of-interest statement: Nothing to declare. Manuscript source: Invited manuscript. Peer-review started: May 29, First decision: July 9, Article in press: October 16, Specialty type: Medicine, research and experimental. Country of origin: Australia. Peer-review report classification. Grade A Excellent : 0. Grade B Very good : B, B. National Center for Biotechnology Information , U. World J Clin Cases. Published online Nov 6. Author information Article notes Copyright and License information Disclaimer.
Author contributions: Jefferies M conducted literature search, sifted the titles, identified full texts, created the content, abstracted the data wrote the first version of the manuscript, reviewed the references, completed final revision of the manuscript; Rauff B helped with literature search and revision of the manuscript; Rafiq S updated the figures, prepared video record; Rashid H and Lam T provided study concept and critical revision of the manuscript.
Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. This article has been cited by other articles in PMC. Abstract Viral hepatitis is one of the major public health concerns around the world but until recently it has drawn little attention or funding from global health policymakers.
Open in a separate window. Figure 1. Hepatitis B Hepatitis B is globally one of the most common and severe infectious diseases that leads to significant morbidity and mortality[ 13 ]. Figure 2. Hepatitis C It is estimated that 71 million people globally have chronic hepatitis C infection[ 16 ], who are at risk of developing liver cirrhosis and liver cancer[ 17 ]. Figure 3. Hepatitis D HDV is commonly seen in the people who are exposed to infected blood products or infected needles of previously infected HBV[ 21 ].
Figure 4. Hepatitis E HEV causes food and waterborne diseases with outbreaks seen worldwide. Figure 5. Americas The prevalence of hepatitis A is high in the Americas, with exception of high-income North American countries. European continent The prevalence of HAV increases from west to east; childhood transmission is less frequent in Eastern Europe while adult transmission is more common[ 40 ]. South-East Asia In most parts of South East Asia HAV seroprevalence continues to be very high, but recent reports suggest that in some parts such as India infection rates are declining.
Education Education programs directed towards disease awareness lowers disease transmission[ 54 , 62 ]. Improvement of socio-economic condition Improvement in socioeconomic status has shown to reduce the prevalence of all types of viral hepatitis. Screening and early detection Screening, early detection and initiation of treatment will prevent further transmission of the virus and reduce morbidities and mortalities among infected individuals[ 68 , 69 ].
Implementing WHO global model The viral hepatitis outbreaks can be controlled with comprehensive global action plans and collaborations. Multi-sectoral coordination Elimination of viral hepatitis requires strong national and international commitments.
Nurse-led approach This model for hepatitis C management was established in prison and provided advice on harm minimisation, diagnosis and treatment.
Peer navigation model People who recover successfully from the infection can work closely with multidisciplinary clinical care team to offer extensive viral hepatitis support, care and access to treatment specifically for those who have barriers to clinical care[ 70 ].
Outreach treatment Providing outreach services is important in viral hepatitis management. Post-exposure prophylaxis Many cases of viral hepatitis occur among health workers due to accidental needle injuries. Footnotes Conflict-of-interest statement: Nothing to declare. References 1. World Health Organization. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol. J Viral Hepat. Persistent hyperendemicity of hepatitis C virus infection in Taiwan: the important role of iatrogenic risk factors.
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Minus Related Pages. References Khudyakov, Y. Antivir Ther, J Infect Dis, BMC Genomics, EBioMedicine ; Hepatitis A. Hepatitis B. Hepatitis C.
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