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      Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

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          Summary

          The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.

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          Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis

          Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden.
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            Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

            Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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              Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China

              China’s hepatitis B virus (HBV) prevention policy has been evaluated through nationally representative serologic surveys conducted in 1992 and 2006. We report results of a 2014 serologic survey and reanalysis of the 1992 and 2006 surveys in the context of program policy. The 2014 survey used a 2-stage sample strategy in which townships were selected from 160 longstanding, nationally representative, county-level disease surveillance points, and persons 1–29 years of age were invited to participate. The 2014 sample size was 31,713; the response rate was 83.3%. Compared with the 1992 pre–recombinant vaccine survey, HBV surface antigen prevalence declined 46% by 2006 and by 52% by 2014. Among children <5 years of age, the decline was 97%. China’s HBV prevention program, targeted toward interrupting perinatal transmission, has been highly successful and increasingly effective. However, this progress must be sustained for decades to come, and elimination of HBV transmission will require augmented strategies.
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                Author and article information

                Contributors
                Journal
                Lancet Gastroenterol Hepatol
                Lancet Gastroenterol Hepatol
                The Lancet. Gastroenterology & Hepatology
                Elsevier Ltd.
                2468-1253
                15 December 2019
                February 2020
                15 December 2019
                : 5
                : 2
                : 167-228
                Affiliations
                [a ]Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
                [b ]Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
                [c ]Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
                [d ]Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
                [e ]Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
                [f ]Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
                [g ]Eijkman Institute for Molecular Biology, Jakarta, Indonesia
                [h ]Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
                [i ]University of Tokyo, Tokyo, Japan
                [j ]Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
                [k ]Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
                [l ]Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
                [m ]Division of Gastroenterology & Hepatology, National University Health System, Singapore
                [n ]Division of General Medicine, Woodlands Health Campus, Singapore
                [o ]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
                [p ]National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
                [q ]Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
                [r ]Genomics Research Center, Academia Sinica, Taipei, Taiwan
                Author notes
                [* ]Correspondence to: Prof Shiv K Sarin, Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi 110 070, India sksarin@ 123456ilbs.in
                Article
                S2468-1253(19)30342-5
                10.1016/S2468-1253(19)30342-5
                7164809
                31852635
                2cad28ea-3c92-4dd4-97d5-11189d3f5244
                © 2019 Elsevier Ltd. All rights reserved.

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