Global Viral Hepatitis: Millions of People are Affected

CDC’s Viral Hepatitis Program Collaborates Worldwide

CDC assists with the implementation of strategiesexternal icon to achieve progress toward global viral hepatitis elimination goals in countries around the world. Collaborative work with partners, including in-country CDC offices, Ministries of Health, the World Health Organization (WHOexternal icon), international public health professionals, and foreign government officials, focuses on efforts to develop, implement, monitor, and evaluate viral hepatitis-related guidelines, policies, plans, and programs. For example, CDC helped implement the country of Georgia’s Hepatitis C Elimination Program, the first program of its kind, and is continuing to provide technical assistance to Georgia as the program progresses toward elimination. Additionally, CDC assisted in the implementation of a pilot program to eliminate hepatitis B and hepatitis C in Uzbekistan using an innovative funding approach tailored to the needs of low- and middle-income countries (3). International collaborations not only help the host country but can help reduce the risk for disease among U.S. travelers abroad and reduce the likelihood that people coming to the United States are infected.

Key Facts

The World Health Organization (WHO) estimates that during 2019(1):

• 296 million people worldwide are living with hepatitis B
• 58 million people worldwide are living with hepatitis C
• 1.5 million people were newly infected with chronic hepatitis B
• 1.5 million people were newly infected with chronic hepatitis C

Both hepatitis B and hepatitis C can lead to lifelong infection. WHO estimates that 1.1 million deaths occurred in 2019 due to these infections and their effects including liver cancer, cirrhosis, and other conditions caused by chronic viral hepatitis (1).

Hepatitis A and hepatitis E infections do not result in chronic infection but can be severe and cause liver damage and death. Outbreaks of these infections occur worldwide, particularly in parts of the world with poor sanitation.

Progress Being Made Worldwide

All types of viral hepatitis can be controlled or prevented.

• Hepatitis C can be cured; a once-daily medication taken by mouth for 8-12 weeks can cure most people who are infected with hepatitis C. In 2019, 9.4 million people were receiving treatment for chronic HCV infection, greater than a nine-fold increase since 2015 (1).
• Medications to manage hepatitis B are available to help prevent liver damage and slow progression of the disease.
• Hepatitis A and hepatitis B can both be prevented with safe and effective vaccines. Efforts to increase the number of children vaccinated against hepatitis B around the world have dramatically reduced the number of new hepatitis B virus (HBV) infections.

Hepatitis A and hepatitis E can also be prevented, and cases reduced with improvements in sanitation, because these infections are transmitted from infected feces either person-to-person or through contaminated food and drinking water.

Global Efforts to Eliminate Viral Hepatitis

In 2016, WHO’s World Health Assembly (WHA) called for global elimination of viral hepatitis by 2030 (4) and set global targets of achieving 90% reduction in new cases of hepatitis B and hepatitis C, a 65% reduction in deaths from hepatitis B and hepatitis C, and treatment of 80% of people living with these infections (4). Individual countries are now in different stages of developing their own viral hepatitis elimination plans (5). At the 2021 WHA, WHO released the Interim Guidance for Country Validation of Viral Hepatitis Eliminationexternal icon providing a global framework for the process and standards for validation of elimination, including absolute impact and programmatic targets (6).

Global Immunization Strategic Framework 2021-2030

In 2021, CDC released the Global Immunization Strategic Framework 2021-2030, which provides a roadmap to achieving progress toward a world where everyone is protected from vaccine-preventable diseases (VPDs), such as hepatitis A and hepatitis B.

Three Goals are core immunization program capacities that CDC seeks to strengthen:

• Prevent VPDs by strengthening immunization services.
• Detect VPDs by supporting and improving disease surveillance systems.
• Respond to and prepare for VPD outbreaks.

Two Goals are cross-cutting capacities:

• Sustain immunization program capacities over time.
• Innovate to increase immunization program impact through research and evaluation.

Current Status of Prevention and Treatment

Safe and effective vaccines to protect against hepatitis A and hepatitis B are available. The hepatitis A vaccine is used in only a few countries; greater use of the vaccine has the potential to control outbreaks. The hepatitis B vaccine is used widely around the world. In 2020, global coverageexternal icon with three doses of hepatitis B vaccine was 83%, and 42% of children received a dose at birth, which is necessary to prevent mother-to-child transmission of this infection. Improving rates of vaccination coverage, especially among infants and children, will reduce HBV infection, which could help reduce rates of liver disease and death.

Even though affordable, safe, and effective treatments can prevent liver disease and liver cancer among people living with hepatitis B and cure those living with hepatitis C, WHO estimated that only 10% of people with hepatitis B and 21% of people with hepatitis C worldwide knew they were infected in 2019. Of these, 22% and 62% had received treatment, respectively. (1).

Global Efforts to Improve Delivery of Hepatitis B Vaccine during Infancy

The safe and effective hepatitis B vaccine has dramatically reduced the number of new hepatitis B virus infections reported worldwide, but many unvaccinated children continue to become infected. The biggest gap in vaccination coverage is caused by the failure to administer a first dose of vaccine within 24 hours of birth. This dose protects infants, particularly infants born to HBV-infected mothers, from the virus. According to WHO, only 43% of children worldwide received a birth-dose of hepatitis B vaccine in 2019 (1).

Learn more about CDC’s work to prevent hepatitis B globally.

References

1. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Available at: https://www.who.int/publications/i/item/9789240027077external icon.
2. CDC. Progress toward hepatitis B and hepatitis C elimination using a catalytic funding model — Tashkent, Uzbekistan, December 6, 2019–March 15, 2020. MMWR 2020; 69(34):1161–5.
3. Draft Global Health Sector Strategies Viral Hepatitis 2016–2021. Available at: https://www.who.int/hepatitis/strategy2016-2021/enexternal icon
4. WHO. Combating Hepatitis B and C to Reach Elimination by 2030. World Health Organization, Geneva; 2016. Available at: https://www.who.int/publications/i/item/combating-hepatitis-b-and-c-to-reach-elimination-by-2030external icon
5. Center for Disease Analysis Foundation. Just 12 countries worldwide on track to eliminate hepatitis C infection by 2030, with United Kingdom, Italy and Spain among those joining the list. 2018 [cited 2019 June 5]; Available from: https://cdafound.org/just-12-countries-worldwide-on-track-to-eliminate-hepatitis-c-infection-by-2030-with-united-kingdom-italy-and-spain-among-those-joining-the-list/?platform=hootsuiteexternal icon.
6. WHO. Interim guidance for country validation of viral hepatitis elimination, 2021. Available at: https://www.who.int/publications/i/item/9789240028395external icon