Hepatitis: 2 million new cases and 1.3 million deaths a year – here’s why we mustn’t let our guard down

There are 287 million people worldwide living with chronic hepatitis B (HBV) and C (HCV). This is the estimate of the World Health Organisation, which states that every year, nearly two million new cases are recorded and over 1.3 million people die from conditions such as cirrhosis and liver cancer: the highest death toll of any infectious disease. In addition to these, the World Hepatitis Alliance points out on its website dedicated to World Hepatitis Day on 28 July that many people have no symptoms and therefore only discover they have the disease when it is too late.

Chronic hepatitis B and C are also widespread in our country, although the number of new infections is reported to be falling. Furthermore, infections with hepatitis A (HAV) and E (HEV) viruses are widespread in countries with poor hygiene and sanitation standards, but they also occur in European countries, including Italia, in the form of both sporadic cases and outbreaks (find out more here). The Italian National Institute of Health (ISS) points out that eliminating hepatitis means preventing cirrhosis, liver cancer, hospital admissions and preventable deaths. In Italia, viral hepatitis has been a serious public health emergency for many years: around ten years ago, the associated mortality rate was almost three times higher than that observed today. The progress made thanks to diagnosis and antiviral treatments shows that these diseases can be prevented and treated, but we must not let our guard down. Today we have simple tests and highly effective treatments; this is why it is essential to take part in screening, to be tested at least once in a lifetime and to seize every opportunity for early diagnosis. The fight against hepatitis must be regarded, in every respect, as a strategy to combat cancer, through HBV vaccination, early diagnosis and the treatment of hepatitis C.

In our country, the Ministry of Health, in collaboration with the ISS, the regions, scientific societies and patient organisations, has been working on a National Action Plan to eliminate viral hepatitis, HIV and sexually transmitted infections (STIs). The Plan, which is currently awaiting approval by the State-Regions Conference, includes strategies to improve prevention and promote early diagnosis and access to treatment, with the aim of significantly reducing new infections and mortality.

“Viral hepatitis remains a major public health issue to this day,” emphasises Anna Teresa Palamara, head of the Department of Infectious Diseases at the ISS, “which our country intends to tackle through a National Plan covering diseases and pathogens that share certain modes of transmission, such as hepatitis, HIV and ISTs. The plan also proposes a series of measures to improve the efficiency of screening and facilitate access to treatment, given that the diagnosis of viral hepatitis has always been a critical issue, as most people do not present obvious symptoms and are tested too late, putting them at risk of developing advanced liver disease.”

In recent years, the ISS, in collaboration with the Ministry of Health, has been working on several fronts to prevent and control hepatitis, implementing measures aimed at achieving the objectives set by the WHO through the activities of ISS facilities linked to local communities. These include the ISS National Reference Laboratory, headed by Anna Rita Ciccaglione, which coordinates the National Network of Regional Reference Laboratories for the Virological Surveillance of Viral Hepatitis, and the SEIEVA surveillance system, coordinated by Maria Elena Tosti, which, through in-depth epidemiological studies of acute hepatitis virus infections, promotes their investigation and control at local and national levels. A further monitoring network is the PITER network (Italian Platform for the Study of Viral Hepatitis Therapies), coordinated by Loreta Kondili, which collects data on patients with chronic viral liver disease caused by hepatitis B, C and Delta viruses. The network generates evidence from clinical practice on care needs and the impact of treatments, to support health policies. The ISS also coordinates projects funded by the Ministry of Health to improve hepatitis C screening, patient management and timely access to treatment, as well as research projects on hepatitis B and Delta. It also participates in European and international initiatives with institutions, networks and scientific stakeholders to tackle inequalities and prevent cancer through HBV vaccination, early diagnosis and hepatitis C treatment. Given the possibility of sexual transmission, the reporting of positive test results for hepatitis B and C viruses has recently been incorporated into the STI Sentinel Surveillance programme, coordinated by Maria Cristina Salfa. The ISS also coordinates projects funded by the Ministry of Health to improve hepatitis C screening, patient management and timely access to treatment, as well as research projects on hepatitis B and Delta. It also participates in European and international initiatives with institutions, networks and scientific stakeholders to tackle inequalities and prevent cancer through HBV vaccination, early diagnosis and treatment of hepatitis C.