New action plan to prevent-control hepatitis infection in the Americas

Health ministers in the Americas have agreed on a series of actions to prevent and control viral hepatitis infection, with emphasis on hepatitis B and C, which affect an estimated 20 million people in the region.

The new Plan of Action for the Prevention and Control of Viral Hepatitis 2016-2019 was approved during last week’s 54th Directing Council of the Pan American Health Organisation (PAHO) held in Washington, DC.

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Globally, hepatitis B and C together cause 80 per cent of all liver cancer deaths globally, equivalent to nearly 1.4 million lives lost each year. Without treatment (which is particularly effective for hepatitis C), many of the 20 million people estimated to have hepatitis B and C in the Americas will go on to develop long-term problems, including cirrhosis and liver cancer.

The new regional plan lays out lines of action to reduce illness, disabilities and deaths from hepatitis and paves the way for eliminating hepatitis B and C as public health problems in the Americas by 2030.

“The regional response to viral hepatitis has lacked focus in the past, but we now have the opportunity to build a vigorous public health approach,” said Marcos Espinal, director of PAHO’s Communicable Diseases and Health Analysis Department. “Today, the possibility of eliminating viral hepatitis is on the horizon.”

Rates of hepatitis infection vary across the region. The Amazon basin is one of the most affected areas, with hepatitis B prevalence estimated at eight per cent. In other areas of the region, prevalence ranges from less than one per cent to four per cent.

PAHO mortality data indicate that about three per cent of all deaths in Latin America and the Caribbean between 2008 and 2010 were due to liver cancer, liver failure, chronic hepatitis, acute viral hepatitis or cirrhosis.

There are effective vaccines to prevent hepatitis A and B that prevent up to 95 per cent of infections, and new treatments for hepatitis C have a cure rate of 90 per cent or more.

PAHO/WHO recommends a first dose of hepatitis B vaccine for newborns within the first 24 hours, followed by two or three additional doses at two, four and six months of age. With support from PAHO’s Revolving Fund for Vaccine Procurement, countries in Latin America and the Caribbean, as of 2013, were reaching 90 per cent of children under age one with the required three doses of hepatitis B vaccine.

Currently, 84 per cent of the region’s babies receive a first dose of the vaccine within their first 24 hours of life, as recommended. This dose is the most important to prevent mother-to-child transmission of hepatitis B. The new plan of action calls on all countries to ensure that all newborns receive their first dose within 24 hours of birth.

New treatments for hepatitis C are highly effective and have fewer side effects than earlier, interferon-based treatments. Some countries are beginning to make these drugs available to patients in advanced stages of the disease, who are at higher risk of developing complications. But these newer treatments are much more expensive, and access to them is limited in most countries of the region.

Jamaica Observer