In the Journals

Key interventions proposed to aid in the elimination of viral hepatitis

Top European government agencies called for key interventions to heighten focus on treating currently infected individuals and reach the goal of hepatitis elimination in Europe in a review of current hepatitis levels and the WHO’s “Global Health Sector Strategy on Viral Hepatitis 2016-2021.”

“The launch of a global strategy aimed at the elimination of viral hepatitis provides an opportunity to increase efforts aimed at tackling the HBV and HCV epidemics. European countries have already made progress in recent years implementing primary and secondary prevention measures,” Erika F. Duffell, MFPH, MPH, of the European Center for Disease and Control, Stockholm, and colleagues from the European Monitoring Centre for Drugs and Drug Addiction wrote. “However, the epidemiological, demographic and socio-political situation is complex in Europe and diversity and inequities in the programmatic responses to the epidemics exist.”

The WHO designed its strategy with the aim to reduce the incidence of chronic hepatitis by 90% and mortality by 65% on a global scale by 2030. The authors advise that to achieve this target, large-scale interventions are necessary, including hepatitis B childhood vaccination, birth-dose vaccination or other mother-to-child transmission preventives, improved systems to assure safe blood transfusions and use of blood products, interventions aimed at preventing transmission among people who inject drugs (PWIDs) and increased testing with linkage to care and treatment.

In collaboration with the WHO, the ECDC and the EMCDDA assessed the current data sources for the organization’s strategy indicators, which were determined to be insufficient. In response to this, the organizations began collecting and collating seroprevalence data from key risk groups and the general population and plan to publish the results.

PWIDs are a risk group of particular concern. According to the authors, while injecting drug use is stable or declining in Europe, prevalence still ranges from one to nine cases per 1,000 people aged 15 to 64 years. Additionally, the proportion of PWIDs with undiagnosed HCV is estimated to be between 24% and 76%. Harm reduction programs, needle and syringe programs and opioid substitution treatment have potential to contribute to reducing transmission along with measures to repress stigma and discrimination.

“Interventions are further hampered as stigma and discrimination surround hepatitis B and C, migrants, [men who have sex with men] and injecting drug use,” the authors wrote. “Stigma and discrimination are both important in Europe in relation to hepatitis B and C and efforts to reducing or eliminating stigma are essential if disease elimination is to be achieved.”

Treating currently infected patients is important to reduce mortality as well as prevent transmission, but antiviral drugs are costly. The authors recommend that joint procurement of medical countermeasures could be an option to help reduce the costs of antiviral treatment and advocacy by non-governmental organizations toward risk groups will decrease the number of patients who remain undiagnosed or untreated.

“Further development of existing monitoring platforms and working to minimize the reporting burden for countries is important and prevention and control efforts for hepatitis could benefit from understanding some of the lessons learnt in relation to HIV in this area,” the authors wrote. “Indeed, developing a standardized monitoring approach for interventions including diagnosis and treatment along the continuum of care, which is already established for HIV, could now be considered for hepatitis B and C.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

Top European government agencies called for key interventions to heighten focus on treating currently infected individuals and reach the goal of hepatitis elimination in Europe in a review of current hepatitis levels and the WHO’s “Global Health Sector Strategy on Viral Hepatitis 2016-2021.”

“The launch of a global strategy aimed at the elimination of viral hepatitis provides an opportunity to increase efforts aimed at tackling the HBV and HCV epidemics. European countries have already made progress in recent years implementing primary and secondary prevention measures,” Erika F. Duffell, MFPH, MPH, of the European Center for Disease and Control, Stockholm, and colleagues from the European Monitoring Centre for Drugs and Drug Addiction wrote. “However, the epidemiological, demographic and socio-political situation is complex in Europe and diversity and inequities in the programmatic responses to the epidemics exist.”

The WHO designed its strategy with the aim to reduce the incidence of chronic hepatitis by 90% and mortality by 65% on a global scale by 2030. The authors advise that to achieve this target, large-scale interventions are necessary, including hepatitis B childhood vaccination, birth-dose vaccination or other mother-to-child transmission preventives, improved systems to assure safe blood transfusions and use of blood products, interventions aimed at preventing transmission among people who inject drugs (PWIDs) and increased testing with linkage to care and treatment.

In collaboration with the WHO, the ECDC and the EMCDDA assessed the current data sources for the organization’s strategy indicators, which were determined to be insufficient. In response to this, the organizations began collecting and collating seroprevalence data from key risk groups and the general population and plan to publish the results.

PWIDs are a risk group of particular concern. According to the authors, while injecting drug use is stable or declining in Europe, prevalence still ranges from one to nine cases per 1,000 people aged 15 to 64 years. Additionally, the proportion of PWIDs with undiagnosed HCV is estimated to be between 24% and 76%. Harm reduction programs, needle and syringe programs and opioid substitution treatment have potential to contribute to reducing transmission along with measures to repress stigma and discrimination.

“Interventions are further hampered as stigma and discrimination surround hepatitis B and C, migrants, [men who have sex with men] and injecting drug use,” the authors wrote. “Stigma and discrimination are both important in Europe in relation to hepatitis B and C and efforts to reducing or eliminating stigma are essential if disease elimination is to be achieved.”

Treating currently infected patients is important to reduce mortality as well as prevent transmission, but antiviral drugs are costly. The authors recommend that joint procurement of medical countermeasures could be an option to help reduce the costs of antiviral treatment and advocacy by non-governmental organizations toward risk groups will decrease the number of patients who remain undiagnosed or untreated.

“Further development of existing monitoring platforms and working to minimize the reporting burden for countries is important and prevention and control efforts for hepatitis could benefit from understanding some of the lessons learnt in relation to HIV in this area,” the authors wrote. “Indeed, developing a standardized monitoring approach for interventions including diagnosis and treatment along the continuum of care, which is already established for HIV, could now be considered for hepatitis B and C.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.