Joint Society Statement for elimination of viral hepatitis
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Hepatitis B, C and D viruses, transmitted through blood and body fluids, may also cause damages in organs other than the liver.</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">•</span><p id="p0020" class="elsevierStylePara elsevierViewall">Hepatitis A and E viruses are transmitted orally and cause acute hepatitis, which may result in acute liver failure and death.</p></li></ul></p><p id="p0025" class="elsevierStylePara elsevierViewall">The World Health Organization (WHO) estimates that as many as 400 million people worldwide are living with chronic hepatitis viral infection.</p><p id="p0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0015"><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">•</span><p id="p0035" class="elsevierStylePara elsevierViewall">Liver cirrhosis is an important cause of mortality globally – more than 1 million people die of cirrhosis, a majority due to viral hepatitis.</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">•</span><p id="p0040" class="elsevierStylePara elsevierViewall">Hepatocellular carcinoma, the most common form of liver cancer, is the third leading cause of cancer deaths, claiming more than 500,000 lives each year.</p></li></ul></p><p id="p0045" class="elsevierStylePara elsevierViewall">The purpose of this statement is to highlight the need for public health interventions to prevent, diagnose and treat viral hepatitis in a timely fashion to reduce the burden of viral hepatitis.</p><p id="p0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0020"><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">•</span><p id="p0055" class="elsevierStylePara elsevierViewall">Despite the enormous burden of viral hepatitis, pa tients with chronic viral hepatitis are often without symptoms until they develop complications of cirrho sis or liver cancer.</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">•</span><p id="p0060" class="elsevierStylePara elsevierViewall">Once symptoms occur, currently available interven tions are often ineffective and/or expensive.</p></li></ul></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Health Care for Viral Hepatitis</span><p id="p0065" class="elsevierStylePara elsevierViewall">Highly accurate diagnostic tests are available for all hepatitis viruses.</p><p id="p0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0025"><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">•</span><p id="p0075" class="elsevierStylePara elsevierViewall">Simple inexpensive blood tests are available in many, but not all countries, to screen and identify patients with viral hepatitis infection.</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">•</span><p id="p0080" class="elsevierStylePara elsevierViewall">Confirmatory blood tests and routine biochemical tests allow early diagnosis of chronic liver disease due to hepatitis viruses before cirrhosis or hepatocellular carcinoma develops.</p></li></ul></p><p id="p0085" class="elsevierStylePara elsevierViewall">For majority of patients with chronic viral hepatitis, namely hepatitis B and C, effective medications are available for treatment. Treatment of chronic viral hepatitis B and C has been shown to reduce cirrhosis, hepatocellular carcinoma and mortality.</p><p id="p0090" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0030"><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">•</span><p id="p0095" class="elsevierStylePara elsevierViewall">The most remarkable recent advance is that the vast majority of patients with chronic hepatitis C can be cured with 8-12 weeks of oral medications with very few side effects.</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">•</span><p id="p0100" class="elsevierStylePara elsevierViewall">Chronic hepatitis B can also be effectively managed by long term suppression of the virus using safe oral medications, similar to HIV treatment.</p></li></ul></p><p id="p0105" class="elsevierStylePara elsevierViewall">The most impactful public health intervention for viral hepatitis is prevention.</p><p id="p0110" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0035"><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">•</span><p id="p0115" class="elsevierStylePara elsevierViewall">Effective vaccines are available for hepatitis A, B and E. Of these, immunization against hepatitis B virus is critically important – universal vaccination of infants starting at birth has been shown to reduce not only the prevalence of the infection of the birth cohort, but also its health consequences including hepatocellular carcinoma later in life.</p></li><li class="elsevierStyleListItem" id="u0060"><span class="elsevierStyleLabel">•</span><p id="p0120" class="elsevierStylePara elsevierViewall">Other important public health measures include elimination of healthcare-related transmission of hepatitis viruses by screening blood and blood products, proper sterilization of dental, medical, and surgical equipment, and implementation of safe injection practices.</p></li><li class="elsevierStyleListItem" id="u0065"><span class="elsevierStyleLabel">•</span><p id="p0125" class="elsevierStylePara elsevierViewall">To reduce transmission of viral hepatitis in injection drug users, harm reduction programs such as needle exchange programs should be available.</p></li></ul></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Public Health Mandate</span><p id="p0130" class="elsevierStylePara elsevierViewall">Given the large burden of viral hepatitis, governments around the world, although not universally, have made various efforts to mitigate its impact. Furthermore, availability of effective means for prevention and treatment makes it feasible to eliminate viral hepatitis.</p><p id="p0135" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0040"><li class="elsevierStyleListItem" id="u0070"><span class="elsevierStyleLabel">•</span><p id="p0140" class="elsevierStylePara elsevierViewall">Recognition of viral hepatitis as an important public health threat motivates implementation of subsequent actions.</p></li><li class="elsevierStyleListItem" id="u0075"><span class="elsevierStyleLabel">•</span><p id="p0145" class="elsevierStylePara elsevierViewall">Accurate data to understand locale-specific information about viral hepatitis informs proper allocation of resources.</p></li><li class="elsevierStyleListItem" id="u0080"><span class="elsevierStyleLabel">•</span><p id="p0150" class="elsevierStylePara elsevierViewall">Screening for undiagnosed chronic viral hepatitis in definable population subgroups has been shown to be cost-effective.</p></li><li class="elsevierStyleListItem" id="u0085"><span class="elsevierStyleLabel">•</span><p id="p0155" class="elsevierStylePara elsevierViewall">Evidence-based treatment guidelines facilitate prioritization of delivery of antiviral therapy.</p></li><li class="elsevierStyleListItem" id="u0090"><span class="elsevierStyleLabel">•</span><p id="p0160" class="elsevierStylePara elsevierViewall">National programs for systematic immunization have resulted in demonstrable benefits on the population level.</p></li><li class="elsevierStyleListItem" id="u0095"><span class="elsevierStyleLabel">•</span><p id="p0165" class="elsevierStylePara elsevierViewall">The significant recent progress made in the management of viral hepatitis is a result of committed funding of research.</p></li><li class="elsevierStyleListItem" id="u0100"><span class="elsevierStyleLabel">•</span><p id="p0170" class="elsevierStylePara elsevierViewall">WHO has set a goal to eliminate viral hepatitis as a major public health threat by 2030.</p></li></ul></p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Recommendation</span><p id="p0175" class="elsevierStylePara elsevierViewall">The leading professional organizations in liver disease, AASLD, EASL, APASL and ALEH, urge governments, healthcare organizations, and non-governmental organizations to implement the following action plans:</p><p id="p0180" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0045"><li class="elsevierStyleListItem" id="u0105"><span class="elsevierStyleLabel">•</span><p id="p0185" class="elsevierStylePara elsevierViewall">Recognize the public health burden posed by viral hepatitis as a priority and establish plans to curb its impact.</p></li><li class="elsevierStyleListItem" id="u0110"><span class="elsevierStyleLabel">•</span><p id="p0190" class="elsevierStylePara elsevierViewall">Deploy data infrastructure to assess the public health impact of viral hepatitis.</p></li><li class="elsevierStyleListItem" id="u0115"><span class="elsevierStyleLabel">•</span><p id="p0195" class="elsevierStylePara elsevierViewall">Establish practice guidelines which make recommendations for immunization, screening, diagnosis and treatment.</p></li><li class="elsevierStyleListItem" id="u0120"><span class="elsevierStyleLabel">•</span><p id="p0200" class="elsevierStylePara elsevierViewall">Develop and implement comprehensive hepatitis prevention programs, including universal vaccination of all newborns against HBV infection.</p></li><li class="elsevierStyleListItem" id="u0125"><span class="elsevierStyleLabel">•</span><p id="p0205" class="elsevierStylePara elsevierViewall">Define at-risk populations for screening for hepatitis B and C virus infection.</p></li><li class="elsevierStyleListItem" id="u0130"><span class="elsevierStyleLabel">•</span><p id="p0210" class="elsevierStylePara elsevierViewall">Make accurate screening and diagnostic tests available and affordable for public health programs.</p></li><li class="elsevierStyleListItem" id="u0135"><span class="elsevierStyleLabel">•</span><p id="p0215" class="elsevierStylePara elsevierViewall">Implement and finance healthcare programs to diagnose and treat individuals with chronic HBV and HCV infection according to the accepted practice guidelines with a goal to minimize and, over time, eliminate the health burden of viral hepatitis.</p></li><li class="elsevierStyleListItem" id="u0140"><span class="elsevierStyleLabel">•</span><p id="p0220" class="elsevierStylePara elsevierViewall">Support research in the laboratory, in patients and in the population.</p></li></ul></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Burden of Viral Hepatitis on Human Health" ] 1 => array:2 [ "identificador" => "s0010" "titulo" => "Health Care for Viral Hepatitis" ] 2 => array:2 [ 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