28 July marks World Hepatitis Day, and the World Health Organization (WHO) has set out the first ever Global Strategy for Viral Hepatitis, which sets a goal of eliminating viral hepatitis as a public health threat by 2030.

Viral hepatitis, which is commonly caused by the Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E viruses, continues to affect millions of people worldwide. According to a study by Imperial College London, viral hepatitis is currently the world’s deadliest infectious disease, surpassing tuberculosis and accounting for more deaths than HIV and malaria together. While deaths from other infectious diseases have dropped in more than two decades, viral hepatitis-associated deaths have grown from 890,000 in 1990 to 1.45 million in 2013.

It is a particularly pressing problem in Southeast Asia, where approximately 350,000 people are killed every year from viral hepatitis, accounting for 40 per cent of all global deaths caused by the disease.

Long-term infection by viral hepatitis can lead to liver cirrhosis and liver cancer. While symptoms of fatigue and jaundice may present in patients, viral hepatitis can often by asymptomatic, especially in the early stages.

The key role of vaccinations

A key part of WHO’s plan to eliminate viral hepatitis depends on increased access to hepatitis testing and hepatitis vaccination. The health organization will be releasing its first hepatitis testing guidelines in 2016.

According to a study in the scientific journal Vaccine, hepatitis B vaccinations have helped to prevent more than 7 million deaths across the Western Pacific region for children born between 1990 and 2014. However, vaccination has yet to reach 100%, especially in the more rural regions of Asia.

“Universal Hepatitis B vaccination would bring the incidence of liver cancer down in the long run,” commented Dr Lee Kang Hoe, senior consultant at the Asian American Liver Centre (AALC) and Gleneagles Hospital, Singapore. “Regular screening of patients with liver cirrhosis and those with viral hepatitis will allow liver cancer to be detected earlier and hopefully, this will translate to better cure rates and longer survival.”

Living donor liver transplants - the future?

In Singapore, recent reports noted that there are more than 54 people waiting for liver transplants at present – more than double the number seen in 2011. Liver transplants are often the only cure for liver cancer and severe liver cirrhosis.

"The availability of living donor liver transplants, where a portion of the healthy liver of the donor is transplanted, can help alleviate waiting times for liver transplants", Dr Lee said to MIMS. AALC, where Dr Lee practises, was the first private medical clinic to offer living donor liver transplants in Southeast Asia.

Prevention is certainly better than cure, and the WHO urges member states to adopt additional measures to prevent the spread of viral hepatitis. Besides aiming for universal vaccination, WHO also hopes to eliminate unsafe needle practices, the leading cause of hepatitis C in countries such as India.

“It is time to mobilise a global response to hepatitits on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis,” said Dr Margaret Chan, WHO director general.

It is estimated that viral hepatitis infection affects 400 million people worldwide. MIMS