Where We Work

African region

Situation:

• Hepatitis B is highly endemic and affects an estimated 60 million people, mainly in West and Central Africa.
• An estimated 19 million adults are chronically infected with hepatitis C.
• Although not well documented, hepatitis D is endemic in Central and West Africa in particular.
• Hepatitis A and hepatitis E outbreaks are common due to poor sanitation and lack of access to clean water, with recent outbreaks of infection reported in Namibia, Niger and Chad.
• Hepatitis is also a growing cause of mortality among people living with HIV. About 2.3 million people living with HIV are coinfected with hepatitis C virus and 2.6 million with hepatitis B virus.

Response:

• In 2016, the region launched a regional framework to eliminate viral hepatitis by 2030.
• The hepatitis B vaccine is administered in all 47 Member States and coverage of the three-dose childhood vaccination is 77%. However, hepatitis B birth-dose was introduced in few countries with a low regional coverage at 11%.
• Forty countries (out of 54) report testing 100% of all blood donations for all transfusion transmitted infections, which include hepatitis B and C.

Tackling the scourge of viral hepatitis effectively will require significant human and financial resources. I therefore call upon countries in the Region to develop strategies to scale up access to counselling, testing and treatment for hepatitis B and C especially in poor and at-risk communities

Dr Luís Gomes Sambo, WHO Regional Director for Africa

Americas region

Situation:

• Around 2.8 million individuals in the Americas Region are infected with hepatitis B (2.1 million of them reside in Latin America and the Caribbean).
• 56% of new hepatitis B infections are due to mother-to-child transmission and 44% to horizontal transmission in all ages.
• Chronic infections beginning in childhood account for 57% of all incident chronic infections.
• Approximately 7.2 million people are affected by hepatitis C in the Americas region (4.1 million are in Latin America and the Caribbean).
• Only 25% of people living with hepatitis C are diagnosed and in Latin America and the Caribbean just 14% of people are aware they have hepatitis C.
• In 2015 only 16% of people diagnosed with hepatitis C were accessing treatment.
• All countries in the region vaccinate children under one year of age against hepatitis B, but 31% do not do so within the first 24 hours of birth, as recommended by WHO.
• The United States has one of the largest populations of people who inject drugs (PWID) and prevalence of hepatitis C is estimated at 72% among this group.
• 3% of all deaths in Latin America and the Caribbean between 2008 and 2010 were due to hepatic cancer, liver failure, chronic hepatitis, acute viral hepatitis and cirrhosis.

 “Viral hepatitis continues to be a silent epidemic. Most people who have hepatitis B or C do not know they have the infection, because the symptoms tend to take a number of years to appear.”

Rafael Mazin, PAHO/WHO Senior Advisor on HIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections unit

Response:

• Some countries have started efforts to expand diagnosis and treatment of viral hepatitis. Brazil, for example, is incorporating the use of rapid diagnostic tests to expand access to treatment, and the United States has begun expanding testing for hepatitis C among people born between 1945 and 1965 and among high-risk groups.
• Quantitative hepatitis B viral load testing is available in 72% of countries.
• Qualitative nucleic acid testing for hepatitis C is available in 65% of countries and genotyping of hepatitis C is available in 63% of the region.
• The hepatitis B vaccine has been incorporated into childhood vaccination schedules in all Latin American and Caribbean countries with average coverage rates of over 90%.
• More than 99% of donated blood in the region is screened for hepatitis B and C.
• In 2015 the region adopted a regional action plan.

This situation is worrying given the high risk of developing chronic infection and complications like cirrhosis and liver cancer. Early detection and access to quality treatment at affordable cost could prevent many people from developing these complications.

Massimo Ghidinelli, Head of PAHO/WHO’s HIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections unit

Eastern Mediterranean region

Situation:

• It is estimated that a total of 22 million living individuals have been infected with HCV, among whom around 15.4 million are chronically infected.
• About 80% of these individuals living with hepatitis C are in Egypt and Pakistan, with each of these countries contributing about 5.1 million and 6.6 million chronic infections respectively.

• There are over half a million people who inject drugs (PWID) in the region and about half of them are infected with hepatitis C.
• There are around 14.8 million people living with chronic hepatitis B infection in the region.
• An estimated 80% of all hepatitis B cases live in eight countries: Pakistan, Sudan, Yemen, Iran, Egypt, Syria, Afghanistan and Morocco.
• It is estimated that 18.8% of people living with hepatitis B in the region are also co-infected with hepatitis D.
• Most of the hepatitis B and C infections in this region are acquired in the healthcare setting, such as through routine dentistry, blood transfusions and operations.
• Viral hepatitis mortality is the 5th leading cause of death in North Africa and the Middle East.

Response:

• Hepatitis B vaccine is incorporated in over 80% of immunisation programmes.
• Thirteen countries (81%) reported having a written strategy or plan for the prevention and control of viral hepatitis.

• A Regional Action Plan for the Implementation of the Global Strategy for Viral Hepatitis 2017 – 2021 in the Eastern Mediterranean region is currently in consultation.

In order to address this public health challenge effectively, we need to ensure that governments put in place a comprehensive approach in which there is a concerted effort between the public sector, civil society, academic and the private sector.

Dr Ala Alwan, WHO Regional Director for Eastern Mediterranean

European Region

Situation:

• 15 million people in the European Region are living with chronic hepatitis B virus infection.
• More than 14 million with chronic hepatitis C virus infection. 
• The main routes of transmission include sharing contaminated needles and equipment in drug use, body piercing, tattooing and acupuncture.
• Over 171,000 die every year from hepatitis B or C in Europe – more than 400 deaths a day, or approximately 2% of all deaths.
• Two thirds of people with hepatitis B or C in the region live in Eastern Europe and central Asia.

• The epidemiology of hepatitis B in the WHO European Region is diverse; prevalence ranges from extremely low (<  0.1%) in northern Europe to high (>  10%) in countries in central Asia
• Member States in eastern and southern parts of the Region still face a heavy burden due to chronic HBV infection in older age cohorts.
• In most countries of western and northern Europe, the majority of cases are now registered as imported, and the burden is considerably higher among immigrants from countries with high prevalence. Migrants account for an estimated 25% of chronic hepatitis B cases and 14% of chronic hepatitis C cases in the region.
• Certain groups, such as people with multiple sexual partners, men who have sex with men (MSM), people who inject drugs (PWID) and health care workers, are at increased risk of HBV infection.
• The burden of chronic hepatitis C is disproportionately high among PWID and MSM in HIV-infected populations.
• Historically, new infections typically occurred through blood transfusions and other forms of nosocomial transmission, though injection drug use now accounts for 80% of new HCV infections, with a known transmission route in European Union/European Economic Area (EU/EEA) countries.  

Response:

• All donated blood is now screened for hepatitis B and C.
• Two of the most effective preventative methods are raising awareness of the risks and adopting harm reduction policies.
• In 2016, WHO EURO launched a regional strategy to eliminate viral hepatitis by 2030.

Hepatitis B and C each affects up to 2% of the population in the WHO European Region [...] We need to take urgent action, in close collaboration with our partners, to address this neglected and silent epidemic.

Zsuzsanna Jakab, WHO Regional Director for Europe

South-East Asia Region

Situation:

• In South-East Asia, there are 39 million people living with hepatitis B. 
• 10 million people in the region are living with hepatitis C.
• There are an estimated 6.5 million symptomatic cases of hepatitis E and 400,000 cases of hepatitis A in the region each year.

• The prevalence of chronic hepatitis B is above 8% in three countries: Democratic People's Republic of Korea, Myanmar and Timor-Leste
• A recent study estimated hepatitis C infection rates in the general population at 2.7% in Thailand, 1.7% in Myanmar, 1.3% in Bangladesh, 1.3% in India and 0.8% in Indonesia.
• 50% of people who inject drugs in the region have hepatitis C.

Response:

• The hepatitis B vaccine is included in childhood immunisation programmes throughout the region. More than 24 million doses of the hepatitis B vaccine are administered in the region annually but only 7 countries have implemented the birth dose.

• The South-East Asia region adopted a regional action plan in 2016.

We must adopt coordinated national strategies based on the local epidemiological context. The battle against hepatitis cannot be won by ministries of health alone. […] Most importantly, the public must be armed with information to prevent viral hepatitis.

Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia 

Western Pacific region

Situation:

• The region has one of the highest rates of prevalence of hepatitis B in the world with around 115 million people living with hepatitis B (6.2% of the population).
• There are more than 14 million people living with hepatitis C in the Western Pacific (1% of the population).
• The region bears 40% of the world’s deaths caused by hepatitis (1500 deaths every day).
• Liver cancer is the second most common cause of cancer deaths in the Asia–Pacific region, and approximately 78% of liver cancer cases are a result of chronic viral hepatitis B or C. China alone accounts for over 50% of the global liver cancer death toll.

Response:

• The region was the first to set the goal of reducing the prevalence of hepatitis B infection to less than 2% among children 5 years of age by 2012 and to less than 1% prevalence by 2017, through universal three-dose hepatitis B and birth-dose vaccination of infants.
• The region adopted its regional action plan in 2016.

Given the high endemicity of viral hepatitis in the region – especially hepatitis B and C – we need to increase focus on prevention and screening, but also redouble our efforts in the treatment of those already infected.

Dr Shin Young-soo, WHO Regional Director for the Western Pacific