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
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