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 Disease

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

Hepatitis C IncidenceHepatitis C Incidence

Forecasted cases of hepatitis C for 2001–2040

Health care costs associated with hepatitis C for 2001–2040

Predicted HCV Related DeathsPredicted HCV Related Deaths

Predictions are difficult,

Particularly about the future

Yogi Berra

HCV Related Mortality USAHCV Related Mortality USA

Wise, 2008

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 !

Thank youThank you

www.who.int

http://www.who.int/topics/hepatitis/en/