The 28th of July marks the first ever World Hepatitis Day. At the World Health Assembly in 2010, countries unanimously adopted a resolution calling for concerted action to address the viral hepatitis issue. July 28 was designated World Hepatitis Day, serving as an opportunity to promote specific actions towards preventing and controlling these viruses and the disease they cause.
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. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of contact with infected body fluids, such as through contaminated blood or blood products, invasive medical procedures using contaminated equipment. Hepatitis B can be transmitted from mother to baby, between family member, and by sexual contact. Types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver disease and cancer.
The Western Pacific Region has almost half the global cases of hepatitis B, while having only a third of the world's population. Countries in the region have committed to reducing hepatitis B infection rates in children to less than 2% by 2012 and to less than 1% as a future goal. Dr Shin Young-soo, WHO Regional Director for the Western Pacific, said reaching the target is crucial and do-able. "Focused, concerted action is essential, especially in the countries in the Region that continue to suffer from high rates of mother-to-child transmission of hepatitis B virus," he said.
The World Health Organization (WHO) pledged to focus on nine countries in the Western Pacific Region facing significant challenges in meeting the 2012 target to reduce hepatitis B infection rates among children. The nine countries are Cambodia, Kiribati, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Vanuatu and Viet Nam.
While most countries in the region have reduced hepatitis B infection rates in children to less than 2%, the nine are not yet there, mainly because of low vaccination coverage. In many of these countries, a major cause of low vaccination rates is the high number of births that occur at home without skilled birth attendants, making it difficult to deliver vaccines and other care services.
The theme of World Hepatitis Day in the Western Pacific Region is: "Knock down hepatitis B by 2012". "Hepatitis B is a preventable disease. Prevention starts at birth, with an effective and safe vaccine that breaks the chain of transmission. The virus is highly contagious and can easily pass to newborn infants after exposure to their mother's blood during childbirth. The vaccine can prevent infection even after exposure to the virus, but the baby needs to be vaccinated within 24 hours of birth, followed by two other timely vaccine doses later."
In Viet Nam hepatitis B infection is present in 10% to 20% of the general population and is the cause of up to more than 80% of liver disease and cancers in the country. Co-infection rates amongst people living with HIV are also around 10%.
In 2003, Viet Nam put in place a universal, infant hepatitis B vaccination program that increased coverage to 94%. Hepatitis B vaccination within 24 hours of birth reached more than 60% of newborns by 2005. However, due to cases of unrelated death after immunization in 2006, many doctors in hospitals stopped birth dose vaccination and coverage dropped down to around 20%. Viet Nam's Ministry of Health has since made concerted efforts to increase the administration of birth dose vaccination and coverage is slowly recovering.
Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents. Treatment can be very expensive and access is limited in developing countries.
Hepatitis C is also a contagious viral infection of the liver, but for which no vaccine has yet been developed. Hepatitis C infections are found worldwide with some 130-170 million people chronically infected.
Hepatitis C in Viet Nam is a growing concern. People who inject drugs have especially high prevalence of hepatitis C infection, with up to 98.5% of them infected with the virus in Viet Nam.
Reducing the risk of infection with hepatitis C requires avoiding unsafe injections and unscreened blood products. Improved infection control in health care settings and blood transfusion practice, and harm reduction programs for HIV prevention such as needle, syringe and condom distribution, are also critical to preventing transmission of hepatitis B and C.
Combination therapy with the medications interferon and ribaviron remains the mainstay of hepatitis C treatment, but they are costly and not yet widely available in Viet Nam. However, in Viet Nam a generic, lower-cost version of the drug, peginterferon alfa 2a, has recently been produced. Furthermore, scientific advances and intense research are leading to the development of many new oral anti-viral drugs for hepatitis C infection. However, much still needs to be done to ensure that these advances can be accessible in limited resource settings.