Hepatitis on track to overtake TB as world’s biggest infectious killer
Viral hepatitis is set to become the world’s biggest infectious killer, taking over from tuberculosis (TB) for the first time, new data reveals.
Hepatitis B and C viruses now claim as many lives as TB, with 1.3 million deaths in 2022 new data from the World Health Organization (WHO) shows.
By 2040, the disease will kill more people than TB, HIV and malaria combined unless urgent action is taken, warn experts.
“Despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated,” the WHO Director-General Dr Tedros Adhanom Ghebreyesu said.
Dr Graham Cooke, Professor of Infectious Diseases at Imperial College London said the virus – which is spread through blood-to-blood contact – had been largely “missed” by global health experts.
“Viral hepatitis isn’t getting the attention it needs globally, partly because when the Global Fund was set up for HIV, TB and malaria, the burden of viral hepatitis wasn’t recognised,” he said.
Prof Cooke added that there had been a “transformation in treatments, particularly for hepatitis C”, in the last 10 years.
“This means that in low-income countries, the rise in the epidemic due to growing populations is not matched by resources to tackle them,” he said.
Two-thirds of all hepatitis infections are concentrated in just ten countries; Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, Russia, and Vietnam.
But developed countries are also impacted.
In the UK, estimates suggest around 270,000 people live with hepatitis B and C, with at least half undiagnosed.
The hepatitis B and C viruses – which account for 83 and 17 per cent of global hepatitis deaths respectively – are the most severe strains, and together are the primary causes of liver cirrhosis and liver cancer worldwide.
Symptoms include fatigue, jaundice and nausea. However, in many people, the infection is symptomless – only 20 to 25 years after the initial infection might they discover they have end-stage liver damage.
Both hepatitis B and C are contracted through blood-to-blood contact, including from mother to child during childbirth, sexual contact, the sharing of needles, and inadequate sterilisation of medical equipment.
Over 96 per cent of people with new chronic hepatitis B infections in Britain are migrants who acquired the infection in their country of birth during early childhood, whilst most hepatitis C infections – over 90 per cent – are caused by injecting drugs from dirty needles.
In the UK, screening is reserved for certain groups, explained Dr Will Irving, Professor of Immunology at the University of Nottingham. Pregnant women, blood donors, and healthcare workers are routinely tested.
“If you don’t fall into those groups, you may not get tested for years – although you might be fit and healthy at the moment, patients might only come for care when they have end-stage liver disease,” he said.
A new NHS England testing initiative, announced this week, aims to identify those unknowingly living with hepatitis C through new rapid liver scanning and portable testing units.
The programme is set to be deployed through clinical outreach vans at drug and alcohol support services and some GP practices – with hopes of eliminating the disease in the UK by 2025.
Those who have ever injected drugs, had medical treatment abroad, or had unprotected sex with an at-risk partner are encouraged to get checked, and will be given effective antivirals to treat the disease if they test positive.
But treatment for both hepatitis C and B varies greatly across the globe.
“The drugs that have been developed are extraordinarily effective – they’ll cure around 95 per cent of patients, but having the drugs is one thing and getting the drugs to the countries that need it is another,” said Dr Irving.
There is a vaccine to protect against hepatitis B, which should be administered in early childhood. However, many countries, particularly in the global south, do not have access to it.
In Africa, where 63 per cent of new hepatitis B infections occur, only 18 per cent of newborns are offered the jab.
There is currently no cure for hepatitis B, meaning that, once contracted, it can become chronic and lead to severe – and fatal – liver damage.
Antivirals can help manage the condition and reduce the risk of developing cancer and cirrhosis, but in 2022, only three per cent of those living with chronic hepatitis B received any form of treatment.
Hepatitis C can be completely cured with antivirals sofosbuvir and daclatasvir. Still, only 20 per cent of those living with the infection – 12.5 million people – are treated each year.
This is partly due to huge disparities in the pricing of these medicines, meaning many countries fail to procure them.
“Low-income countries continue to pay prices much higher than the benchmark price, such as $1,050 in the Democratic Republic of the Congo and US$ 481 in Cameroon for the sofosbuvir/daclatasvir fixed-dose combination,” the WHO said in its most recent report.
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