Why viral hepatitis is 'nicknamed' the silent killer and even more dangerous than HIV or Tuberculosis.

Putting an end to global health's 'silent killer'.

By Gottfried Hirnschall.

There’s a reason viral hepatitis has been dubbed the “silent killer.”

People generally know very little about viral hepatitis, a disease of the liver caused by five different viruses. In fact, most of the 400 million people with chronic hepatitis B and C, the most serious forms of viral hepatitis, don’t know that they are infected. This enables the infection to go unnoticed, and undiagnosed, until the virus has caused serious liver damage. This, in turn, has resulted in viral hepatitis becoming the seventh leading cause of death worldwide. Together hepatitis B and C cause approximately 80 percent of all liver cancer deaths and kill close to 1.4 million people every year — more than either HIV or tuberculosis.

This silent, hidden evolution has meant that for decades hepatitis has been one of the poor relations of global public health — its impact underestimated, services underresourced and minimal political attention paid. Despite this neglect, a wide range of effective tools exist to both prevent and treat hepatitis.

Hepatitis B and C are transmitted through blood and bodily fluids. Infections can be prevented by using only sterile equipment for injections and other medical procedures, and testing all donated blood and blood components for hepatitis B and C. Similarly, people who inject drugs can be protected by providing them with sterile injection equipment. Children in most of the world’s countries now routinely receive hepatitis B vaccine — and are thus protected from infection for life. Safer sex practices, including minimizing the number of partners and using condoms and other barrier measures, also protect against transmission.

The most notable advances in the field of hepatitis are in the area of treatment. Recently developed medicines can cure most people with hepatitis C and can control hepatitis B infection. People who receive these medicines are much less likely to die from liver cancer and cirrhosis and much less likely to transmit the virus to others.

In part as a result of these advances, public health leaders are increasingly calling for more to be done to reduce the health burden from these infections. More and more are raising the possibility that viral hepatitis could be eliminated. Last year, at the World Health Assembly, 194 countries approved a resolution calling for measures to improve prevention, diagnosis and treatment of viral hepatitis and called on the World Health Organization to assess the feasibility of eliminating hepatitis. They also agreed to consider a range of measures to improve access to effective and affordable hepatitis medicines and diagnostics.

A number of countries have already taken concrete steps to do so — Egypt has substantially increased the number of people receiving treatment for hepatitis C in recent years, Georgia has set a goal for the national elimination of hepatitis C, and China has dramatically reduced the rate of hepatitis B infection in children by promoting universal vaccination.

At the same time, countries asked the WHO Secretariat to continue to help them develop robust strategies and goals on hepatitis and to report regularly on the progress of such programs. WHO has responded by providing guidance to countries on developing a national hepatitis response that is tailored to a country’s particular circumstances. WHO is also drafting the first global strategy for the control of hepatitis. This strategy is based on the principles of universal access and includes ambitious targets to reduce infections and deaths from hepatitis, with the goal of eliminating hepatitis B and C by 2030.

But to make a real difference, it will be critical to establish the sort of global political commitment that has built up around other communicable diseases — notably HIV, tuberculosis, malaria and polio.