In 2013, viral hepatitis was a leading cause of death worldwide. It led to 1.46 million deaths, more than HIV, tuberculosis or malaria. This figure has risen consistently since 1990.
More than 90 percent of deaths are due to the sequelae of infections with the hepatitis B virus (HBV) and hepatitis C virus (HCV). Prevention can reduce the rate of new infections, but the number of people already infected would remain high for a generation. Without a dedicated effort, the mortality rates will continue to rise.
Treatment now can prevent deaths in the short- and medium term. Combining this with prevention to combat hepatitis makes elimination by 2030 a realistic goal. So how close is New Zealand to reaching that goal, and what do we as a country need to do to achieve it?
According to Hepatitis Foundation of New Zealand chief executive Susan Hay, several things can be done. These include increasing diagnosis of HBV infection, eencouraging all HBsAg-positive New Zealanders to join the foundation’s long-term monitoring programme, linking all people living with active hepatitis (CHB) with antiviral therapy and linking all HBsAg+ people for HBV CURE clinical trials within the next five years.
Ms Hay says the foundation is in a good position to provide national leadership and increase diagnosis rates.
“We provide hepatitis education and training for GPs and nurses and help ensure patients who fall through the cracks are picked up. These people frequently face barriers to health care such as geographic or monetary barriers”
Hepatitis B affects older people who weren’t vaccinated under the national programme introduced in 1989. People of Maori, Pacific Island and east Asian descent are most at risk. New Zealand has a high migration of southeast Asian – predominantly Chinese – and Pacific Island people; many are infected prior to vaccination programmes beginning in their home countries.
There are 120,000 New Zealanders living with CHB.
“We estimate 50 percent of people with hepatitis B are diagnosed, but only 7000 are being treated,” Ms Hay says. “There should be three times this number. This means we need to use our patient register nationally to ensure patients aren’t retested, and that those who need treatment get it. This means doubling identification of new diagnoses and tripling the number of people being treated.”
Reaching the five service coverage targets set by the World Health Organisation (WHO) can eliminate hepatitis as a public health threat. Study and analysis results suggest that, if the viral hepatitis response reaches five prevention and treatment service coverage targets (see attached image), hepatitis B and C could be eliminated as a public health threat.
“Currently New Zealand meets the prevention and harm reduction targets, but not those for diagnoses and treatment,” Ms Hay says.
Reducing infections and deaths would require a comprehensive health sector approach. The Hepatitis Foundation has also developed a draft national hep B plan to help support this national strategic approach. Furthermore, its national enrolment register helps track hepatitis management progress, while its long-term monitoring of people with hepatitis B improves liver health outcomes.
Through this Ministry-of-Health-funded national monitoring programme, the foundation cares for 25,000 New Zealanders living with hepatitis B. The programme includes access to community hepatitis nurses and specialist care if needed, regular blood tests, liver assessment, hepatitis B resources and information, advice and support. To enrol please phone 0800 33 20 10 or complete an online self-enrolment form.