In a landmark achievement, incidence of chronic hepatitis B has successfully dropped below 1% in children under five, reaching the 2020 goal set at the 2016 World Health Assembly, said World Health Organization Director-General Dr. Tedros Adhanon Ghebreyesus on Monday.

The target reduction in hepatitis B virus (HBV) incidence in children was met in 2019, a rare case where global health goals were achieved within the intended timeline. The achievement, announced just ahead of World Hepatitis Day, provides a much-needed boost of morale for the embattled global health community in the wake of this year’s pandemic and its knock-on effects on other disease areas. 

“HBV has been a scourge in many countries for so many decades”, said WHO’s Head of Health Emergencies Mike Ryan. “To see incidence [of hepatitis B] less than 1% in children is just incredible”

“I know it doesn’t sound like it, but we should take these successes because they’re true victories for global health.”

The reductions in HBV incidence in children were largely thanks to the wide deployment of a childhood vaccine against the virus. 

Still, Dr Tedros warned that countries must stay on guard.

Disruption of essential services, like vaccination against Hepatitis B, could result in five million additional chronic hepatitis B (HBV) infections in children born between 2020 and 2030, as well as one million additional HBV-related deaths among those children later on, according to a study by Imperial College London and WHO which has not been published yet. 

Additionally, the hepatitis death toll could skyrocket because of coronavirus-related disruptions, warned Dr. Tedros. Hepatitis infections can cause liver damage and liver cancer, and currently claim 1.3 million lives a year. 

Globally, about 325 million people live with hepatitis B and C, the most deadly of the five types of hepatitis disease.

Hepatitis B Vaccine Coverage Threatened During Coronavirus Pandemic

As a result of the pandemic, disruption of essential hepatitis services, like HBV vaccination of infants, threatens to claim thousands of additional lives, added panelists at the WHO briefing.

“Even in the midst of the COVID-19 pandemic, we must ensure that mothers and their babies have access to life-saving services including hepatitis B vaccinations. Preventing transmission of hepatitis B from mother-to-child and in early childhood is the most important strategy for controlling the disease and saving lives”, said Dr. Tedros.

Mother-to-child transmission is responsible for the brunt of new HBV infections, and the virus claims nearly 900,000 lives each year. Boosting vaccine coverage is particularly important in WHO’s African Region, where HBV vaccine coverage at birth is ten times lower than the global average of 42%.

“For regions such as sub-Saharan Africa with low access to the vaccine, increasing coverage of a timely birth dose is the priority,” emphasized Doherty.

Some countries have successfully maintained essential services for other infectious diseases like measles despite the pandemic, suggesting the same could be done for HBV. Ethiopia, for instance, has successfully vaccinated almost 15 million children against measles during the pandemic, according to a report from WHO’s African region on Monday.

The HBV vaccine can protect against the virus in more than 95% of cases, and has been proven to be safe after nearly four decades of use.

WHO Issues New Hepatitis Guidelines To Prevent Mother-to-Newborn Transmission

On Monday, Dr. Tedros also called on countries to implement two new recommendations to prevent onward transmission of HBV from pregnant women to their newborns.

As part of the new guidance, pregnant women that are HBV-positive and present a high viral load can protect their newborns through preventive antiviral therapy from the 28th week of pregnancy until birth.

The antiviral of choice, tenofovir, only costs $3 per month in many regions of the world.

However, in settings where viral load testing is unavailable, women are encouraged to use the low-cost “HBeAg” antigen test to assess their infection status, recommends the WHO.

Battle Against Hepatitis C Continues Amidst High Medicines Costs and Barriers To Diagnosis

In recent years, so-called “direct acting antivirals” have also prevented thousands of deaths from hepatitis C (HCV) for as little as $60 in some regions, Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes, said on Monday. A typical treatment course on these drugs is twelve weeks.

However, these lifesaving drugs are still out of reach for many patients in high- and middle-income countries, where a twelve-week treatment course can even climb to $3000 given the absence of special licenses with generic companies to produce the drugs at a cheaper price, Doherty told Health Policy Watch.

“Not all countries will have access to the [cheaper] generics, though more and more countries have access now [over 105 countries] to some of the direct acting antivirals.”

She also added that without access to testing, “the medicines will remain out of reach”, as she referred to the fact that only 19% of HCV patients (13.1 million) are diagnosed with HCV, and only 7% of people with HCV (5 million) are treated for the disease, according to WHO data from 2017.

Image Credits: WHO, Flickr: CDC Global, WHO, WHO.