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HEPATITIS Viral hepatitis is caused by five different viruses, and transmission occurs through contaminated food or water (hepatitis A and E) or through exposure to blood or body fluids (hepatitis B, C, D). Viral hepatitis infection kills an estimated 1.45 million per year, with approximately 90% of deaths due to chronic HBV and HCV infection, which cause cirrhosis and liver cancer. 12 The majority (85%) of viral hepatitis deaths occur in Asia, North Africa, East Africa and West Africa. A comprehensive set of hepatitis prevention interventions exists (Table 5.2) and effective treatment can cure more than 90% of patients with chronic HCV infection and suppress viral replication of hepatitis B. Despite the high disease burden and available prevention and treatment interventions, hepatitis has not received the same attention as other diseases with a comparable burden of disease, such as HIV, TB or malaria. Table 5.2. Elements of a comprehensive hepatitis prevention programme Virus A E A B B C B C B C A B C Prevention intervention Safe water and food Hepatitis A vaccination according to the country's epidemiological situation Hepatitis B vaccination for all children and administration of birth dose Access to safe blood (universal screening of all blood donations in a quality-assured manner) Access to sterile injections and other invasive medical equipment in formal and informal health settings Access to sterile injection equipment and other harm-reduction measures for people who inject drugs Promotion of safe sex practices ACHIEVEMENTS Vaccination: The reduction in HBV infections as a result of hepatitis B vaccination programmes is the greatest achievement in hepatitis control. By the end of 2014, 194 countries had introduced the vaccine into their immunization schedules. 104,105 Global coverage with three doses of hepatitis B vaccine is estimated to be 82% (Figure 5.20) and is as high as 92% in the WHO Region of the Americas and the Western Pacific Region. The Western Pacific Region is on track to reach its goal of reducing the prevalence of chronic HBV infection to
SUCCESS FACTORS Hepatitis B vaccination: Support by GAVI led to reductions in the price of hepatitis B vaccine and its introduction in the routine vaccination schedule as a component of the pentavalent vaccine. This led to a dramatic increase in immunization coverage. Injection safety: The Safe Injection Global Network (SIGN) was created with the support of partners, including PEPFAR. Its three core strategies are: to promote behaviour change among patients and health-care workers in order to reduce unnecessary injections and ensure safe practices; to increase the availability of essential and good quality injection devices and supplies; and to properly manage sharps disposal. Harm-reduction programmes: Expansion of sterile needle and syringe programmes, opioid substitution treatment for opioid users and peer outreach programmes have resulted in significant reductions in risk behaviours, although the high infectivity of HCV requires enhanced harm-reduction programmes. New treatments: Dramatic progress in drug development has yielded a number of safe, oral treatment regimens that can cure almost all chronic HCV infections and suppress hepatitis B viral replication. CHALLENGES Lack of political engagement: Viral hepatitis was not included in the MDGs, reflecting a general lack of political engagement and funding. As a result, hepatitis control did not feature prominently in international health strategies such as those promoted by WHO and much will need to be done to address this gap. STRATEGIC PRIORITIES Combating hepatitis is now an explicit SDG target (part of Target 3.3). In 2014, the World Health Assembly requested that WHO initiate a process to examine the feasibility of eliminating hepatitis B and hepatitis C. Accordingly, a Global Health Sector Strategy on Viral Hepatitis is under development that will set global targets towards the elimination of HBV and HCV as public health threats by 2030. 110 Vaccination will remain a priority preventive intervention, along with expanding blood and injection safety within and beyond health-care settings, and taking harm-reduction programmes to scale for people who use drugs. Expansion of treatment will require innovations in diagnostics, including point-of-care technologies, reductions in prices of medicines and a public health approach to treatment and care. Implementation of the global strategy will aim to achieve a 90% reduction in new cases of chronic HBV and HCV infection and hepatitis deaths from 1.4 million to fewer than 500 000 by 2030. To achieve this impact, services will need to be expanded to achieve universal access to HBV vaccination (including birth dose), safe injections and harm reduction, and 80% of people with chronic hepatitis receiving treatment. Table 5.2 shows the priority interventions of a comprehensive programme, including prevention of transmission through safe water, safe sex, and safe medical practices as well as vaccination. Strategic information: There is a lack of reliable data on infection incidence and prevalence as well as for health outcomes and impact. This lack of data undermines national planning efforts as well as advocacy. Comprehensive programmes: Addressing viral hepatitis requires a holistic approach that involves many components of the health sector. However, only a few countries have comprehensive public health programmes for viral hepatitis. Mother-to-child transmission of hepatitis B: This remains a major source of infection. To minimize this risk, WHO recommends that all children receive a dose of hepatitis B vaccine within 24 hours of birth. Global coverage of the birth dose is currently estimated to stand at just 38%. Hepatitis diagnosis and screening: The majority of people with chronic HBV and HCV infection are unaware of their status until they become sick. Improved and affordable diagnostics and testing approaches are required to identify people with chronic viral hepatitis early. Scaling up care and treatment services: This will be a major challenge that will depend on major reductions in the prices of medicines, particularly for the treatment of chronic HCV infection. INFECTIOUS DISEASES 121
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from M I L L E N N I U M DEVELOPMEN
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WHO Library Cataloguing-in-Publicat
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CONTENTS vii Abbreviations 1 1 From
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7 153 Mental health and substance u
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IHR IPCC ITN LLIN MCV MDG MDR TB mh
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SUMMARY This report aims to describ
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sourced development finance. 11 The
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Despite their overall success, the
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The 13 targets that underpin the br
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Box 1.1 Life expectancy improvement
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40 Advanced research on European he
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SUMMARY The SDGs position health as
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Figure 2.2 Trends in fertility by r
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Ageing Populations around the world
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The recent influx of refugees into
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and implementing policies and progr
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that dialogue is to demonstrate an
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One of the challenges we face as we
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Most recently, the right to health
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2100 Figure 2.15 Global average sur
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Figure 2.17 Proportion of health fa
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42 World development report 2014: r
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3 UNIVERSAL HEALTH COVERAGE
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UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
Page 81 and 82: SUMMARY Deaths among pregnant women
Page 83 and 84: Figure 4.3 MDG and SDG targets rela
Page 85 and 86: have declined from 25% to 14% betwe
Page 87 and 88: Chapter 5). As noted above, there h
Page 89 and 90: Figure 4.8 Wealth-related inequalit
Page 91 and 92: young children. 61 Specific indicat
Page 93 and 94: CHALLENGES Access to skilled care a
Page 95 and 96: CHALLENGES Scaling up effective int
Page 97 and 98: CHALLENGES Leaving no country behin
Page 99 and 100: CHALLENGES Endemic countries: Polio
Page 101 and 102: Figure 4.22 Prevalence of stunting
Page 103 and 104: CHALLENGES Spurring action in count
Page 105 and 106: CHALLENGES Ending child marriage: D
Page 107 and 108: 43 Financing global health 2014: sh
Page 109: 5 INFECTIOUS DISEASES
Page 112 and 113: Infectious and parasitic diseases a
Page 114 and 115: Figure 5.4 Global number of deaths
Page 116 and 117: International TB funding increased
Page 118 and 119: Improving quality of care: The qual
Page 120 and 121: Table 5.1 Summary of specific targe
Page 122 and 123: HIV/AIDS More than 30 years since t
Page 124 and 125: TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 134 and 135: CHOLERA Cholera is an acute diarrho
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
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8 INJURIES AND VIOLENCE
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Injuries, whether sustained acciden
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due to limited data. However, the s
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aiming to stop the predicted increa
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ROAD TRAFFIC INJURIES Every year, a
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VIOLENCE AND HOMICIDE There were an
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WAR AND CONFLICT In 2012, an estima
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DISASTERS Disasters are often assoc
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NOTES AND REFERENCES 1 Global repor
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SUMMARY In September 2015, heads of
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A 10-page declaration precedes the
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THE PLACE OF HEALTH IN THE SDGs 1 H
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that health systems providing integ
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FOLLOW-UP AND REVIEW 9 Monitoring t
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NOTES AND REFERENCES 1 Transforming
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WHO South-East Asia Region: Banglad
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ISBN 978 92 4 156511 0
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