Viral hepatitis is a major international public health challenge. It is up there with other major communicable diseases, such as HIV, tuberculosis and malaria. Globally, viral hepatitis is responsible for an estimated 1.4 million deaths each year – a toll comparable to that of HIV and tuberculosis. Nearly all these deaths are from liver failure or liver cancer.
Looking more closely at viral hepatitis deaths:
The Western Pacific Region bears 40% of the global burden of viral hepatitis. And within our Region, Lao PDR is one of the high burden countries for viral hepatitis.
- about 47% are from hepatitis B; and
- 48% to the hepatitis C.
Preliminary studies suggest that around 8% of Lao PDR’s population is living with chronic hepatitis B virus infection. A further 48,000 people here are living with chronic hepatitis C infection – 0.7% of the population. What all this means in human terms is that 548,000 people in Lao are at risk of dying from liver cancer or liver failure in the coming years – unless they receive treatment for their infection. That is a huge health burden – and a huge human cost.
Cancer is currently the number three cause of mortality in Lao PDR. It is responsible for about 11% of deaths in this country each year (1). A preliminary assessment conducted by WHO suggests around 41% of cancer deaths here are from liver cancer (2). Most of these liver cancer deaths are due to chronic viral hepatitis infection. They could be prevented.
To put this in human terms again, WHO estimates that thousands of Lao people die each year due to chronic viral hepatitis infection. Most of these deaths are from the hepatitis B virus. And most people with hepatitis B caught it from their mothers at birth.
Since 2015, most Lao hospitals screen pregnant women for hepatitis B infection. If the mother has the virus then the child runs a high risk of developing a chronic infection. But babies can be protected if they given the hepatitis B vaccine within 24 hours of being born, and then given follow up injections. WHO is working with the Ministry of Health to ensure all babies born in Lao PDR are protected from hepatitis B.
In many countries, healthcare settings are one of the main places people become infected with hepatitis C. People can be exposed through unsafe medical or dental injections, unsafe blood products and medical procedures. Healthcare workers and facilities can protect their patients, and themselves, by following proper infection prevention and control.
So, although viral hepatitis is a major health burden we can do something about it. Indeed, WHO and the UN are committed to taking on hepatitis by our 2030 Agenda for Sustainable Development. One of its targets calls for specific action to combat viral hepatitis – in order to achieve hepatitis elimination by 2030. This Agenda has been endorsed by Lao PDR, and indeed all other UN member states.
Eliminating viral hepatitis by 2030 is an ambitious goal. It will require a major increase in attention to hepatitis among the pubic and health care providers. It will mean increased funding for hepatitis prevention, testing and treatment services – as part of Universal Health Coverage
Looking at the situation from a technical point of view there are effective WHO recommended approaches available that can end hepatitis epidemics. For example:
- Effective vaccines are available for preventing viral hepatitis A and B infections;
- Timely hepatitis B virus birth-dose vaccination prevents the mother to infant transmission;
- Transmission of viral hepatitis B and C in all health care settings can be prevented through the rigorous application of universal infection control and prevention measures
- New oral medicines and treatment regimens for people with chronic hepatitis C virus infection can achieve cure rates of over 90%; and
- Effective treatment is also available for people with chronic hepatitis B virus infection.
These approaches can and should be incorporating into national technical documents and strategic plans in Lao PDR – though, of course, this needs to be done in ways that take account of the context here. Therefore, as a technical partner, WHO is closely working with the Ministry of Health to address the public health challenge posed by viral hepatitis. This includes supporting the development of:
- A National guideline for testing and treatment of hepatitis B and C; and
- A National Strategic Action Plan on hepatitis.
Today in Lao PDR, we mark World Hepatitis Day 2019. Our message needs to be that everyone can play a part in eliminating hepatitis.
- Parents have a role. You should make sure your children and other kids in your community get fully vaccinated against hepatitis B.
- Journalists certainly have a role: The media can educate and inform people about the risk of viral hepatitis and how to get tested.
- Village heads and community leaders have a role. They can both share information and encourage people to take action to protect themselves and their families.
- Health care providers. Maintaining and applying appropriate infection prevention and control measures in their work place.
I wish the Ministry of Health every success with its World Hepatitis Day event today. WHO will continue to collaborate closely with Lao PDR on viral hepatitis prevention and control. Thank you.