Et globalt perspektiv på virus
hepatitt
Prof O Dalgard
Akershus University Hospital
Verdens Helseorganisasjon
Global vision
A world where viral hepatitis transmission is halted and everyone
living with viral hepatitis has access to safe, affordable and
effective prevention, care and treatment services
Goal
Eliminate viral hepatitis as a major public health threat by 2030
2
Figure 10
Top 50 causes of global years of life lost in 1990
and 2013
GBD GBD 2013 Mortality and Causes of Death Collaborators. Lancet 2015.
Copyright © 2015 Elsevier Ltd Terms and Conditions
The global burden of viral hepatitis from 1990 to
2013: findings from the Global Burden of Disease
Study 2013
• Fra 1990 til 2013 økte antall som døde av virushepatitt
• 1990 0. 89 million
• 2013 1·45 million
– HCV 48%
– HBV 47%
Stanaway et al Lancet 2016
4
Levererelaterte dødsfall globalt
Cowie B, et al. ILC 2015; Global Burden of Disease 2013. Lancet 2015
Stanaway et al Lancet 2016
Virushepatitt, aldersjustert mortalitet
Stanaway et al Lancet 2016
Hepatology
Volume 57, Issue 4, pages 1333-1342, 4 FEB 2013 DOI: 10.1002/hep.26141
http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full#fig3
2.8% (185 millioner)
Hepatology
Volume 57, Issue 4, pages 1333-1342, 4 FEB 2013 DOI: 10.1002/hep.26141
http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full#fig3
• Andel med anti HCV som er HCV RNA positive: 70%
• Anti HCV 185 millioner
HCV RNA positive: 130 millioner
10
Estimert antall dødsfall globalt
Global burden of disease study 2013
11
Fig. 1
En kritisk analyse av prevalensdata HCV
Reported HCV prevalence and infections among adults. (A) Anti-HCV prevalence quality scores.
(B) Anti-HCV prevalence – adults (reported). (C) Anti-HCV prevalence – adults (reported and
estimated). (D) Viraemic prevalence – adults (with reported viraemic rate). (E) Viraemic
prevalence
– adults (reported and estimated). (F) Number of viraemic HCV infections – all ages.
Journal of Hepatology 2014 61, S45-S57DOI: (10.1016/j.jhep.2014.07.027)
Grower J Hepatol 2015
Fig. 1
HCV RNA positive 80 millioner.
Reported HCV prevalence and infections among adults. (A) Anti-HCV prevalence quality scores.
(B) Anti-HCV prevalence – adults (reported). (C) Anti-HCV prevalence – adults (reported and
estimated). (D) Viraemic prevalence – adults (with reported viraemic rate). (E) Viraemic
prevalence – adults (reported and estimated). (F) Number of viraemic HCV infections – all ages.
Journal of Hepatology 2014 61, S45-S57DOI: (10.1016/j.jhep.2014.07.027)
Grower J Hepatol 2015
Prevalence hep C in PWID
Nelseon PK Lancet 2011
Prevalence hep C in PWID
Europe
3 mill
Nelson PK Lancet 2011
Prevalence hep C in PWID
Europ
e
3 mill
Globally
10 mill
Nelson PK Lancet 2011
Figure 3
Burden of HCV related disease atributal to
injecting drug use
Degenhardt L Lancet Inf Dis 2016
The Lancet Infectious Diseases 2016 16, 1385-1398DOI: (10.1016/S1473-3099(16)30325-5)
Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC
BY-NC-ND license Terms and Conditions
Burden of HCV related disease attributal to injecting
drug use
1990
2013
Mean DALY s
1990
Population
attributablle
factor
Mean DALYs
2013
Population
attributable
factor
Western Europe
376 000
44%
705 000
64%
Eastern Europe
73 000
32%
605 000
68%
2 095 000
23%
7 046 000
38%
Global
Degenhardt L Lancet Inf Dis 2016
18
Verdens Helseorganisasjon
Global vision
A world where viral hepatitis transmission is halted and everyone
living with viral hepatitis has access to safe, affordable and
effective prevention, care and treatment services
Goal
Eliminate viral hepatitis as a major public health threat by 2030
19
Global hepatitis startegy- Targets
20
Konklusjon
• WHO anslår at komplikasjoner til virushepatitt er den syvende
viktigste dødsårsak i verden.
• Effektiv behandling, vaksine og god kunnskap om forebygging
tilsier at hepatitt som globalt folkehelseproblem kan kontrolleres
innen 2030
21