Hepatitis: a silent killer in the African Region and worldwide

The burden of viral hepatitis, though not accurately known, is believed to be one of the highest in the world. Every year on 28 July, WHO and partners mark World Hepatitis Day to increase the awareness and understanding of viral hepatitis and the diseases that it causes. All countries in the African Region consider viral hepatitis an urgent public health issue.

Viral hepatitis affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year.
There are five know hepatitis viruses: A, B, C, D and E. The most common forms of the disease are hepatitis A, hepatitis B and hepatitis C.

Hepatitis A
Hepatitis A infection is estimated to be high in all Member States of the African Region. A safe effective hepatitis A vaccine has been available for nearly two decades.

Hepatitis B and C
Hepatitis B is highly endemic in West Africa with a prevalence of 8%, the highest in the world. It is also estimated that 2% of the population in the Region are chronically infected with hepatitis C.
Hepatitis B is preventable with a safe and effective vaccine, but there are 240 million people living with hepatitis B virus infection worldwide. While hepatitis C is not preventable by vaccination, current treatment regimens offer high cure rates that are expected to further improve with upcoming new treatments.
Effective and safe antiviral agents against hepatitis B and hepatitis C exist. However, the high price of these medicines remains a major challenge.
Countries that are least able to deal with these diseases also experience the greatest number of deaths due to viral hepatitis. Liver cancer, the fifth most common cancer worldwide, is the most common cancer among men and third most common in women in Africa (Hepatitis, improving the health of patients with viral hepatitis, p.2).

Hepatitis D and E
Although not well documented, hepatitis D is endemic in the Region, especially in Central and West Africa.
The hepatitis E virus exists worldwide, with 20 million infections causing 70 000 deaths annually. Recent outbreaks were reported in Chad, the Sudan and Uganda. Hepatitis E vaccine candidates have been developed but not yet certified by WHO.

Progress in Africa
The African Region has made enormous efforts in hepatitis prevention. According to AHO data, hepatitis B immunization coverage among 1-year old children in the Region has increased from 42% in 2005 to 72% in 2012 (see AHO Atlas figures 4.4.25, 4.4.26 and 4.4.27).
Compared to the other WHO regions, the African Region has registered the greatest progress from 2000 to 2012 (see AHO Atlas figure 4.4.28).


Tools for evidence-based decisions
The precise burden of viral hepatitis and the related risk factors in the African Region have not been fully quantified due to limited research on hepatitis, inaccurate data, inadequate surveillance and lack of cancer registries.
The WHO Regional Committee for Africa urges Member States to establish strong and well-resourced surveillance to detect viral hepatitis transmission and disease (Viral hepatitis: Situation analysis and perspectives in the African Region).
In April this year, WHO issued new recommendations on the treatment of hepatitis C. They are intended for policy-makers, government officials, and others developing programmes for the screening, care and treatment of persons with hepatitis C infection in low and middle-income countries. According to this document, treatment is successful in the majority of persons treated, and success rates in low and middle-income countries are similar to high-income countries.


Useful documents and tools

The Atlas of African Health Statistics 2014

Publications on viral hepatitis

The Model Essential Medicines List

The WHO Global Hepatitis Network

Fact sheets on hepatitis A, B, C and E

World Hepatitis Day 2014 campaign materials

World Health Assembly resolution (WHA 67.6) to promote a comprehensive response to viral hepatitis, May 2014