Worldwide 52 million children living with viral hepatitis

3 Nov 2017 Tara Farrell

World Hepatitis Alliance calls for better screening expectant mothers and treatment of children

 New data presented at this year’s World Hepatitis Summit in Sao Paulo, Brazil (1-3 November) show that 52 million children are living with viral hepatitis worldwide, compared to 2.1 million children living with HIV/AIDS.

 An estimated 325 million people were living with viral hepatitis worldwide in 2016. Of these, 4 million were children living with hepatitis C (under 19 years) and 48 million (under 18 years) were children living with hepatitis B. Both viruses can lead to liver disease, liver cancer and deaths.

 “Children are suffering a huge burden of viral hepatitis worldwide, and the public health implications of this are enormous,” says Raquel Peck, CEO of World Hepatitis Alliance. “Most infected infants and children are not diagnosed, prioritised or treated effectively.”

 According to new analysis on hepatitis C in children, from Manal El-Sayed, Professor of Pediatrics at Ain Shams University, Cairo, Egypt, and Dr Homie Razavi and his team from the Polaris Observatory, the Center for Disease Analysis (CDA) Foundation, Lafayette, CO, USA, just 21 countries* are responsible for around 80% of these pediatric hepatitis C infections, with the highest prevalence rates generally found in developing countries.

 Mother to Child Transmission is one of the main causes of hepatitis C in children. However, neither pregnant women nor young children with this cancer-causing illness can be treated with the highly-effective direct-acting antiviral (DAA) medications. Various regulatory agencies such as the US FDA and the European Medicines Agency have now approved DAAs for use in children aged 12 years and over*. But in high-income countries, there is as yet little evidence they are being used in this age group. WHO is also yet to recommend DAA in any children regardless of age.

 As a result, almost all children are only treated with older pegylated interferon regimens, which often have severe side effects including stunting growth, influenza-like symptoms, anaemia and weight loss, and do not always cure the virus. Trials of DAA drugs in children under 12 years are also ongoing, but they have not been approved yet in any country for these younger children.

 “Currently, 4 million children are living with hepatitis C, which can be cured and 48 million with hepatitis B, which has a vaccine”, said Charles Gore, President of the World Hepatitis Alliance. “Enough is enough. Governments and global health organisations must ensure all children are vaccinated for hepatitis B and provided with DAAs for hepatitis C, and that all pregnant women are screened.”

 Compared to hepatitis C, new hepatitis B infections among children are declining –from approximately 4.7% prevalence in the pre-vaccination era of the early 1980s to 1.3% – due to scaled-up efforts to prevent mother-to-child transmission and global coverage with the three doses of hepatitis B vaccine. Currently, 84% of countries offer hepatitis B vaccinations. However, coverage with the initial birth dose vaccination needed to provide protection to newborns, is still low at 39%.

 Cases of hepatitis C in children are, however, likely to continue growing for years to come, given the lack of prevention and control programs for pregnant women living with hepatitis C and women of child bearing age. This is exacerbated by the absence of a public health approach for case definition and management of expectant mothers or children.

 “We must act and treat as many children as possible. The economic and social benefit of early hepatitis C treatment in children is substantial,” Professor El-Sayed explains. “This includes avoiding disease progression, removing social stigma and improving activity and school performance, and reducing fatigue. However, the fundamental principle is to avoid transmission by adopting ‘cure as prevention’ at an early age and before high risk behaviours emerge that enable transmission.”

 “Children are the future.” Peck concluded. “It’s imperative that we get it right from the beginning and give them the best possible start in life. Without eliminating viral hepatitis amongst children, its elimination will be impossible”.

 Professor Manal H El-Sayed, Ain Shams University, Cairo, Egypt. Please e-mail first to arrange interview. E) manalhelsayed@yahoo.co.uk

 Alternative Contact: Tony Kirby of Tony Kirby PR Ltd. T) Brazil +55 19 9999 71955 +44 7834 385827 E) tony@tonykirby.com

 Tara Farrell, Head of Communications, World Hepatitis Alliance. T) Brazil +55 19 9999 71955 / +44(0)7761625256 E) Tara.farrell@worldhepatitisalliance.org

                           

Notes to editors:

 For limited country level data on hepatitis C in children from Polaris, see:

 http://tonykirby.com/hepatitis/hepCpaediatricselectedcountries.pdf

 WHO only has estimates of hepatitis B prevalence in children under 5 years old, for which the global estimate is 8.9 million cases. The global estimate of 48 million children under 18 years old with hepatitis B infection comes from the Polaris Observatory. For a table showing WHO 2015 data of country prevalence of chronic hepatitis B in children under 5 years (the group most likely to develop lifelong problems and die from the infection in later life), see:

http://tonykirby.com/hepatitis/hepBprevunder5bycountry.xlsx

*The US FDA and European Medicines Agency have approved Sofosbuvir/Ledipasvir Fixed dose combination (known as HARVONI-brand name) 12 weeks was approved for all genotypes except 2 and 3. Sofosbuvir plus Ribavirin 24 weeks for genotypes 2 and 3 for children and adolescents above 12 years and weighing more than 35 kg. 

 https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm551407.htm

 The figure below shows the 21 countries containing around 80% of the estimated burden of hepatitis C in children aged 0-19 years:

 

About Viral Hepatitis

Viral hepatitis is inflammation of the liver caused by a virus. The Global Burden of Data findings illustrate that the total deaths cause by viral hepatitis, including acute cases, cirrhosis and liver cancer account for 1.34 million deaths globally. There are five different hepatitis viruses - hepatitis A, B, C, D and E. Hepatitis A is spread mainly through ingestion of contaminated food and water and the disease is often endemic in countries with a lack of safe water and poor sanitation. Hepatitis B is transmitted through contact with the blood or other bodily fluids of an infected person and approximately 257 million people are living with chronic infections. Hepatitis C is mainly spread through blood-to-blood contact such as unsafe injection practices and inadequate sterilisation of medical equipment. Today, 69 million people are living with the disease. Hepatitis D is passed on through contact with infected blood and only occurs in people who are already infected with hepatitis B. Hepatitis E, like hepatitis A, is transmitted through ingesting contaminated food or water.

The World Hepatitis Summit 2017   

Between 1 – 3 November 2017 a global audience of civil society groups, World Health Organization and its Member States, patient organisations form the World Hepatitis Alliance’s 249 organisational members, policy-makers, public health scientists and funders will come together in Brazil, at the World Hepatitis Summit, to galvanise the global response to viral hepatitis. The World Hepatitis Summit is a joint initiative between World Health Organization (WHO) and the World Hepatitis Alliance - in collaboration with a different host country for each Summit. Its mission is to support countries in meeting the targets needed to eliminate viral hepatitis.

http://www.worldhepatitissummit.org/  

The World Hepatitis Alliance

The World Hepatitis Alliance (WHA) is a patient-led and patient driven non-governmental organisation. With 252 member patient groups from 84 countries, WHA works with governments, national members and other key partners to raise awareness of viral hepatitis and influence global change. To achieve a world free from viral hepatitis, WHA provides global leadership in advocacy, awareness-raising and the fight to end its social injustice.

About the Center for Disease Analysis (CDA) Foundation

 The CDA Foundation is a public health research firm based Lafayette, Colorado, USA, with expertise in epidemiology and disease modelling. One of its main areas of focus is the epidemiology of the hepatitis B, C, and D viruses, which is done through its Polaris Observatory data centre.

 http://www.thecdafoundation.org/

 http://polarisobservatory.org/

 References

  1. El-Sayed MH, Razavi H. Global estimate of HCV infection in the pediatric and adolescent population. J Hepatol. 2015;62:S831-32,P1263.
  2. Hepatitis C – paediatric data, CDA Foundation, Lafayette, CO, 2017. Data from the Foundation’s Polaris Observatory – http://polarisobservatory.org/ (data as of October 2017, unpublished)
  3. The Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2016; published online Dec 15. http://dx.doi.org/10.1016/ S2468-1253(16)30181-9.
  4. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis. 2014; 59(6):765-73.

5.   Centers for Disease Control and Prevention (CDC). Hepatitis C virus infection among adolescents and young adults:Massachusetts, 2002-2009. MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):537-41

6.   Thursz M, Fontanet A. HCV transmission in industrialized countries and resource-constrained areas. Nat Rev Gastroenterol Hepatol. 2014;11(1):28-35.

7.    CDC. Viral hepatitis surveillance—United States, 2015. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm