Viral hepatitis kills more people annually than HIV/AIDS, tuberculosis (TB), or malaria in most countries, with death rates dramatically increasing by 63 percent over a period of 23 years, according to a large study.

Whereas deaths from other infectious diseases, including TB and malaria, have dropped in more than two decades, viral hepatitis-associated deaths grew from 890,000 in 1990 to 1.45 million in 2013. In the same year, the number of deaths was 1.3 million for HIV/AIDS, 1.4 million for TB, and 855,000 for malaria.

The vast majority or 96 percent of viral hepatitis deaths worldwide were attributed to hepatitis B and C, which promote cirrhosis and liver cancer. Most deaths occurred in East Asia.

The two hepatitis strains may be manifested by symptoms of nausea, fatigue, and jaundice. Most people, however, may remain symptomless and unaware of their infection until serious complications develop.

Long-term hepatitis infections with hardly any immediate symptoms may potentially explain the rise in death rates, said principal study author Dr. Graham Cooke from the Department of Medicine at Imperial College London.

“Although we have had an effective hepatitis B vaccine for some years, there is still a large proportion of the world which is unvaccinated. We have no similar vaccine for hepatitis C,” Cooke added.

Aside from the mentioned, the study also revealed that the overall disease burden of hepatitis infection is now shared evenly between high- and low-income countries.

In Singapore, hepatitis B-induced liver cancer cases in males is on the rise, growing by 30 percent over a decade, from about 1,700 cases between 2003 and 2007 to 2,200 cases between 2010 and 2014, according to statistics from the National Registry of Diseases Office. Meanwhile, a hepatitis C outbreak was reported last year, infecting 25 people and likely contributing to seven deaths. (See also: Liver cancer cases due to Hepatitis B on the rise; Singapore General Hospital apologises for Hepatitis C outbreak in October.)

“The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health,” Cooke said. MIMS