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The Global Burden of Hepatitis C Dr Daniel Lavanchy World Health Organization (WHO)

The Global Burden of Hepatitis C Dr Daniel Lavanchy World Health Organization (WHO) Geneva, Switzerland 3 rd Paris Hepatitis Conference. Global Burden of Disease. For centuries, mankind helpless against infectious diseases

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The Global Burden of Hepatitis C Dr Daniel Lavanchy World Health Organization (WHO)

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  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 (>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

  5. 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

  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. 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

  8. 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.

  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

  10. Hepatitis C Incidence

  11. Forecasted cases of hepatitis C for 2001–2040

  12. Health care costs associated with hepatitis C for 2001–2040

  13. Predicted HCV Related Deaths Predictions are difficult, Particularly about the future Yogi Berra

  14. HCV Related Mortality USA Wise, 2008

  15. GlobalHepatitis 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

  16. 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

  17. 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

  18. 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

  19. Hepatitis C Vaccine • Investigational E1E2/MF59 vaccine (Novartis) • Correlates of protection are complex • Future development ? • Urgent !

  20. Thank you www.who.int http://www.who.int/topics/hepatitis/en/

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