Thursday, 28 July 2022

by Prof Peter Karayiannis, Professor of Microbiology at the University of Nicosia Medical School.

The World Health Organisation (WHO) estimates that there are currently about 300 million chronic hepatitis B, 45 million chronic hepatitis C and around 15 million chronic hepatitis D carriers. The disease burden in Europe is 25 million, of which 14.4 million are living with hepatitis B and more than 11 million with hepatitis C. Chronic liver disease long-term predisposes the sufferer to the development of cirrhosis, hepatocellular carcinoma and liver failure leading to death. Available antiviral drugs can suppress viral replication in the case of hepatitis B, whilst a cure is possible with those against hepatitis C in up to 99% of cases. The hepatitis B vaccine can prevent infection with hepatitis B and D, since the latter requires the hepatitis B virus for its successful replication.

In 2016, the WHO Global Health Sector Strategy (GHSS) on viral hepatitis set 2030 as the target for the elimination of viral hepatitis as a public health problem. To this end, a 90% reduction in incidence and a 65% reduction in mortality were estimated necessary in order to be on target for 2030, compared with a 2015 baseline. The WHO provided a framework to be followed by countries to assess their efforts in reducing both new infections of hepatitis B and C, and deaths from liver cirrhosis and cancer, alongside with the use of highly effective intervention programs reaching high coverage (>90%) on the way to attaining elimination. These preventative approaches include vaccination of infants at birth, blood transfusion and injection safety, and harm reduction, e.g. in intravenous drug users, as well as HBV/HCV screening by testing and offering timely treatment. These capabilities vary from country to country and therefore adjustments may be necessary along the way.

Ideally, countries should aim to eliminate both hepatitis B and C together, or pursue one of the following options of elimination:

  • Option A: Mother-to-child transmission (EMTCT) of HBV.
  • Option B: HCV alone.
  • Option C: HBV alone, or
  • Option D: Elimination of both HBV and HCV together.

For this to be achieved certain barriers need to be overcome such as improvements in access to treatment and care, involvement of patient organisations, simplified viral hepatitis testing, speedy linkage to care, and above all, monetary support to achieve all this.

The SARS-CoV2 pandemic starting at the end of 2019 and still ongoing nearly three years later has derailed the programs of elimination in many countries. Resources have been diverted elsewhere since health care systems were called upon to manage the pandemic.  The Cyprus Ministry of Health has in recent months re-activated the Advisory Committee on Viral Hepatitis in an attempt to put on track the plans for elimination, which in the case of Cyprus should still be achievable by 2030.