The%20Global%20Burden%20of%20Hepatitis%20C

1
The Global Burden of Hepatitis C Dr Daniel
Lavanchy World Health Organization (WHO) Geneva,
Switzerland 3rd Paris Hepatitis Conference
2
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

3
Global Burden of Disease
4
Global Burden of Disease

• About 15 million (gt25) 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

5
End-stage Liver Disease

• Cirrhosis gt 783'000 deaths / year
• Liver cancer gt 619'000 deaths / year
• 1 of every 40 death worldwide
• But no good breakdown according to aetiology

6
Hepatitis C Global Burden

• WHO estimates
• 2.3 - 4.7 millions new infections/year
• 300'000 deaths annually
• 130-170 million persons chronically infected

7
(No Transcript)
8
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

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.

10
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 gt RNA positive confirmed in 40-90
• EMCCDA. Annual report 2006

11
Hepatitis C Incidence
12
Forecasted cases of hepatitis C for 20012040
13
Health care costs associated with hepatitis C for
20012040
14
Predicted HCV Related Deaths
Predictions are difficult, Particularly about
the future

Yogi Berra
15
HCV Related Mortality USA
Wise, 2008
16
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

17
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

18
(No Transcript)
19
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

20
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

21
Hepatitis C Vaccine

• Investigational E1E2/MF59 vaccine (Novartis)
• Correlates of protection are complex
• Future development ?
• Urgent !

22
Thank you
www.who.int http//www.who.int/topics/hepatitis/
en/