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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/