World Hepatitis Day, observed annually on July 28th, took place this Tuesday, with the aim to raise awareness of hepatitis, and encourage prevention, diagnosis and treatment. The theme for this year’s campaign – ‘Prevent hepatitis. Act now’ – aims to help prevent transmission of viral hepatitis through better awareness and services that improve vaccinations, blood and injection safety, and reduce harm.
‘The annual campaign aims not only to raise awareness among the general public and infected patients, but also to urgently promote improved access to hepatitis services, particularly prevention interventions, by policymakers.’ WHO
The theme of World Hepatitis Day 2015 was preventing hepatitis (www.worldhepatitisday.org)
World Hepatitis Day has been on July 28th following the adoption of a resolution during the 63rd World Health Assembly in May 2010, which stated that ‘28 July shall be designated as World Hepatitis Day in order to provide an opportunity for education and greater understanding of viral hepatitis as a global public health problem, and to stimulate the strengthening of preventive and control measures of this disease in Member States’. Since then, World Hepatitis Day is recognised in over 100 countries through a huge range of events, such as free screenings, vaccination drives, poster campaigns, and concerts.
As is the norm for awareness events such as this in the 21st century, the day this year was driven by a social media campaign, with #WorldHepatitisDay and #4000lives trending across the world as individuals and organisations demonstrated their support for the cause, highlighting the number of people who die every day due to hepatitis. BIVDA were one of 963 twitter users who took part in a #4000voices thunderclap that reached nearly 25 million people, and at its peak, almost 1,500 #WorldHepatitisDay tweets were being sent every hour.
The scale of the problem that this day is trying to address is underpinned by some of the numbers involved. Every year 1.4 million people die from viral hepatitis. Worldwide, 400 million people are living with hepatitis B or C, whilst nearly 1 in 3 people across the globe has been infected by hepatitis – that’s around 2 billion people! Most hepatitis B and C sufferers do not know that they are infected, increasing the risks of developing severe liver disease and well as transmitting the virus to others.
In the UK, national estimates suggest around 214,000 individuals are chronically infected with hepatitis C, with Public Health England reporting that UK deaths from hepatitis C have quadrupled in 16 years to some 400 in 2012. Since injecting drug use continues to be the most important risk factor for HCV infection in the UK, PHE has called for treatment and tests to expand to non-traditional settings, such as prisons, primary care and drug treatment centres. Indeed, a liver health program has been in place in Welsh prisons since 2012, promoting diagnostic testing for hepatitis. (PHE’s 2014 report on hepatitis C in the UK can be found here.)
The number of reported cases of hepatitis C infection in England has consistently risen in the past 20 years (Hepatitis C in the UK: 2014 report, Public Heath England)
PHE believe there is an urgent need for better monitoring of patients and wider testing for people at risk. Diagnostic testing is clearly a crucial weapon in the battle against hepatitis. There are a variety of antibody and antigen tests that can help diagnose and/or monitor hepatitis caused by the specific hepatitis viruses. For example, hepatitis C is diagnosed with two blood tests: an antibody test (enzyme immunoassay for antibodies) and the PCR test (molecular detection of HCV genetic material). The use of PCR can demonstrate the presence or absence of the virus, as well quantitate viral load and identify genotype, whilst the antibody test demonstrates past or present infection.
Furthermore, in addition to tests for the specific virus, there are also diagnostic tests to aid diagnosis and monitoring of liver function and disease progression, which is particularly important since liver disease is often asymptomatic. ALT and AST levels, for example, which indicate the degree of inflammation, can be 20-50 times higher than normal due to hepatitis. Other liver function tests including measuring alkaline phosphatase, gamma GT, bilirubin and albumin levels also help ascertain the state of the liver as a result of hepatitis. Clotting studies may also be carried out as worsening chronic liver disease results in prolonged prothrombin time.
90s band Right Said Fred led the efforts to encourage people to get tested for hepatitis C on Tuesday with charity Liver4Life through the #ImNotTooSexyToGetTested campaign, which includes a new version of their 1991 debut single ‘I’m Too Sexy’, plus appearances on ITV and Sky news. They even had time to retweet BIVDA’s storify of the day!
Right Said Fred worked with Liver4Life on the ‘I’m not too sexy to get tested’ campaign for World Hepatitis Day (www.not2sexy.com)
Attempts to limit and ultimately eliminate hepatitis will require a collaborative approach, encouraging vaccination, regular testing for at-risk individuals, and effective treatment. It is clear once again, though, that in vitro diagnostics play an essential role, allowing identification of the disease first before attempts to treat the problem can begin.