Viral hepatitis, the silent epidemic

Globally as many people (1.5 million) die each year from viral hepatitis as from HIV/AIDS, but whereas the latter viral disease attracts government and international action and funding, the former is comparatively neglected. It was for this reason that the WHO initiated World Hepatitis Day four years ago, to be observed on the 28th July each year, and the lack of awareness about the repercussions of viral hepatitis was reflected in this year’s theme of ‘Hepatitis: think again’. So far five hepatitis viruses have been identified, though Hepatitis D is only found as a co-infection with B. Whilst the acute infections that food- and water-borne Hepatitis A and E cause are not insignificant in terms of their incidence, morbidity and mortality, it is Hepatitis B and C (HBV and HCV), that are generating a global public health crisis.
These two viral infections have major characteristics in common with HIV/AIDS. The acute infection, acquired by exposure to infectious blood and other body fluids as well as by sexual and vertical transmission, is frequently asymptomatic in the case of HCV. Acute infections can be followed by a period of clinical latency and thus the unwitting transmission of the virus to others. Though such chronic infections with HBV are very uncommon in healthy adults, they occur in over half of young children infected; between 75% – 85% of people infected with HCV develop a chronic infection. After years or even several decades of chronic, asymptomatic infection, cirrhosis of the liver and hepatocellular carcinoma can result. The WHO estimates that there are around 780,000 deaths from acute and chronic HBV infection, and more than 350,000 from chronic HCV infection annually. Even more alarming is that currently 500 million people are chronically infected with either HBV or HCV.  
As is the case with HIV/AIDS, avoiding exposure to infectious blood and semen and diagnostic testing of asymptomatic people can help to contain the global viral hepatitis epidemic. However, now the pertinent characteristics of the disease have been elucidated, it should be far more feasible to control viral hepatitis than HIV/AIDS, a disease for which there is no vaccine and no drugs that actually eradicate the virus. There is a highly effective vaccine for HBV, though approved drugs help prevent serious
liver damage but don’t eliminate the virus. Drugs are now available that can eradicate the HCV virus, and clinical trials are currently testing
a vaccine for chronically infected people.
“Hepatitis: think again”. With appropriate education and adequate national and international funding, this looming global health crisis could be averted.