In the Journals

Viral hepatitis causes more deaths than HIV, malaria, TB

Despite recent advances in hepatitis C treatment and the availability of hepatitis vaccinations, deaths attributable to viral hepatitis have exceeded those caused by all other chronic infectious diseases, including HIV, malaria and tuberculosis, according to findings from the Global Burden of Disease study.

“It’s outrageous, but not surprising,” Charles Gore, president of the World Hepatitis Alliance said in a press release. “This is largely due to a historic lack of political prioritization coupled with an absent global funding mechanism.”

Viral hepatitis remains a leading cause of death worldwide

The Global Burden of Disease (GBD) study assesses cause-specific mortality in 195 countries. The study showed that in 2016, 1.34 million deaths were related to viral hepatitis, including liver cancer, acute cases, cirrhosis, hepatitis A, E, B, C and D, according to the World Hepatitis Alliance. This exceeded the number of deaths from TB (1.2 million), HIV/AIDS (1 million) and malaria (719,000). Viral hepatitis remained one of the top 10 leading causes of death worldwide, which also included heart disease, road accidents and Alzheimer’s disease.

To reverse this trend, the World Hepatitis Alliance is calling for additional efforts to improve hepatitis testing and diagnosis rates. The organization reported that only 5% of people with viral hepatitis are aware of their condition.

Raquel Peck
Raquel Peck

“World leaders and national decision-makers must heed these findings and note that with targeted funding, political prioritization and specific interventions, hepatitis deaths can be avoided,” Raquel Peck, CEO of the World Hepatitis Alliance, said in the release.

Deaths due to infectious diseases decline worldwide

Additional data from the GBD study demonstrated an overall decline in the number of deaths caused by infectious diseases. From 2006 to 2016, there was a 50% or more reduction in deaths caused by diphtheria (66.4%), tetanus (59.5%), measles (72.5%), leishmaniasis and visceral leishmaniasis (54.1% each) and African trypanosomiasis (76.3%). There were also reductions in deaths caused by TB (20.9%), HIV/AIDS (45.8%), lower respiratory infections (8.2%), upper respiratory infections (26.2%), meningitis (8.4%), malaria (25.9%), schistosomiasis (22.1%), yellow fever (11.8%), rabies (47.4%) and sexually transmitted infections (26%), including syphilis (27%), chlamydial infection (4.5%) and gonococcal infection (5.9%).

WHO partly attributed these reductions to progress toward the Millennium Development Goals, which specifically aim to reduce the global incidence of HIV, malaria and TB.

“The global focus on these diseases led to substantial increases in external funding, which permitted the massive scale-up of effective interventions worldwide over a short period of time,” a WHO spokesperson told Infectious Disease News. “This contributed to the substantial reductions in cases and deaths due to these diseases over the last 10 years. If these global efforts for prevention and treatment were stopped, mortality and disease burden would rebound for all three diseases.”

Despite these reductions, there was a significant rise in deaths caused by dengue, which increased 81.8%, and extensively drug-resistant TB (XDR-TB), which increased 67.6%. Several factors may have contributed to these increases, WHO said. For dengue, these include improvements in surveillance, increased urbanization and travel, and climate change.

“The incidence of dengue has increased 30-fold over the last 50 years, and the year 2016 was characterized by large dengue outbreaks worldwide,” the WHO spokesperson said. “Careful clinical detection and management of dengue patients can significantly reduce death rates from severe dengue.”

Although there was a large increase in deaths caused by XDR-TB, they accounted for less than 1% of the overall TB mortality rate in 2016, according to WHO. To counter the increasing trend, WHO called for the development and uptake of new medications and tools for drug-susceptibility testing as well as systematic screening interventions of contacts and high-risk groups. Research for these drugs and tests, however, is severely underfunded, the representative said.

“More than $800 million per year is urgently needed to fund research for new anti-TB medicines to end TB,” he added.   

In light of the large Zika virus outbreak, Zika virus disease was added as a cause of death in the GBD study. The researchers reported that two deaths occurred in 2015 and 19 in 2016.

“Given trends in the disease, we do not expect the number of Zika virus disease deaths to increase substantially in the coming years,” they wrote. – by Stephanie Viguers

Disclosures: Please see the study for all authors’ relevant financial disclosures.

Despite recent advances in hepatitis C treatment and the availability of hepatitis vaccinations, deaths attributable to viral hepatitis have exceeded those caused by all other chronic infectious diseases, including HIV, malaria and tuberculosis, according to findings from the Global Burden of Disease study.

“It’s outrageous, but not surprising,” Charles Gore, president of the World Hepatitis Alliance said in a press release. “This is largely due to a historic lack of political prioritization coupled with an absent global funding mechanism.”

Viral hepatitis remains a leading cause of death worldwide

The Global Burden of Disease (GBD) study assesses cause-specific mortality in 195 countries. The study showed that in 2016, 1.34 million deaths were related to viral hepatitis, including liver cancer, acute cases, cirrhosis, hepatitis A, E, B, C and D, according to the World Hepatitis Alliance. This exceeded the number of deaths from TB (1.2 million), HIV/AIDS (1 million) and malaria (719,000). Viral hepatitis remained one of the top 10 leading causes of death worldwide, which also included heart disease, road accidents and Alzheimer’s disease.

To reverse this trend, the World Hepatitis Alliance is calling for additional efforts to improve hepatitis testing and diagnosis rates. The organization reported that only 5% of people with viral hepatitis are aware of their condition.

Raquel Peck
Raquel Peck

“World leaders and national decision-makers must heed these findings and note that with targeted funding, political prioritization and specific interventions, hepatitis deaths can be avoided,” Raquel Peck, CEO of the World Hepatitis Alliance, said in the release.

Deaths due to infectious diseases decline worldwide

Additional data from the GBD study demonstrated an overall decline in the number of deaths caused by infectious diseases. From 2006 to 2016, there was a 50% or more reduction in deaths caused by diphtheria (66.4%), tetanus (59.5%), measles (72.5%), leishmaniasis and visceral leishmaniasis (54.1% each) and African trypanosomiasis (76.3%). There were also reductions in deaths caused by TB (20.9%), HIV/AIDS (45.8%), lower respiratory infections (8.2%), upper respiratory infections (26.2%), meningitis (8.4%), malaria (25.9%), schistosomiasis (22.1%), yellow fever (11.8%), rabies (47.4%) and sexually transmitted infections (26%), including syphilis (27%), chlamydial infection (4.5%) and gonococcal infection (5.9%).

WHO partly attributed these reductions to progress toward the Millennium Development Goals, which specifically aim to reduce the global incidence of HIV, malaria and TB.

“The global focus on these diseases led to substantial increases in external funding, which permitted the massive scale-up of effective interventions worldwide over a short period of time,” a WHO spokesperson told Infectious Disease News. “This contributed to the substantial reductions in cases and deaths due to these diseases over the last 10 years. If these global efforts for prevention and treatment were stopped, mortality and disease burden would rebound for all three diseases.”

Despite these reductions, there was a significant rise in deaths caused by dengue, which increased 81.8%, and extensively drug-resistant TB (XDR-TB), which increased 67.6%. Several factors may have contributed to these increases, WHO said. For dengue, these include improvements in surveillance, increased urbanization and travel, and climate change.

“The incidence of dengue has increased 30-fold over the last 50 years, and the year 2016 was characterized by large dengue outbreaks worldwide,” the WHO spokesperson said. “Careful clinical detection and management of dengue patients can significantly reduce death rates from severe dengue.”

Although there was a large increase in deaths caused by XDR-TB, they accounted for less than 1% of the overall TB mortality rate in 2016, according to WHO. To counter the increasing trend, WHO called for the development and uptake of new medications and tools for drug-susceptibility testing as well as systematic screening interventions of contacts and high-risk groups. Research for these drugs and tests, however, is severely underfunded, the representative said.

“More than $800 million per year is urgently needed to fund research for new anti-TB medicines to end TB,” he added.   

In light of the large Zika virus outbreak, Zika virus disease was added as a cause of death in the GBD study. The researchers reported that two deaths occurred in 2015 and 19 in 2016.

“Given trends in the disease, we do not expect the number of Zika virus disease deaths to increase substantially in the coming years,” they wrote. – by Stephanie Viguers

Disclosures: Please see the study for all authors’ relevant financial disclosures.