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      Update on global epidemiology of viral hepatitis and preventive strategies

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          Abstract

          Viral hepatitis is one of the major public health concerns around the world but until recently it has drawn little attention or funding from global health policymakers. Every year 1.4 million people die from viral hepatitis-related cirrhosis and liver cancer. However, the majority of the infected population are unaware of their condition. This population have significant obstacles to overcome such as lack of awareness, vulnerability, increased migration, disease stigma, discrimination, as well as poor health resources, conflict in policy development and program implementation. Despite implementing infection control measures over the last few decades eradication or significant disease reduction remains elusive. This study aims to present the current global prevalence status and examines potential elimination strategies. The information for this research were obtained through a systematic review, published scientific literatures, the official websites of various government organisations, international public health organisations and internationally recognised regulatory bodies over a period of 40 years between 1978 and 2018.

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          Most cited references57

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          Hepatitis A virus seroprevalence by age and world region, 1990 and 2005.

          To estimate current age-specific rates of immunity to hepatitis A virus (HAV) in world regions by conducting a systematic review and meta-analysis of published data. The estimation of the global burden of hepatitis A and policies for public health control are dependent on an understanding of the changing epidemiology of this viral infection. Age-specific IgG anti-HAV seroprevalence data from more than 500 published articles were pooled and used to fit estimated age-seroprevalence curves in 1990 and 2005 for each of 21 world regions (as defined by the Global Burden of Disease 2010 Study). High-income regions (Western Europe, Australia, New Zealand, Canada, the United States, Japan, the Republic of Korea, and Singapore) have very low HAV endemicity levels and a high proportion of susceptible adults, low-income regions (sub-Saharan Africa and parts of South Asia) have high endemicity levels and almost no susceptible adolescents and adults, and most middle-income regions have a mix of intermediate and low endemicity levels. Anti-HAV prevalence estimates in this analysis suggest that middle-income regions in Asia, Latin America, Eastern Europe, and the Middle East currently have an intermediate or low level of endemicity. The countries in these regions may have an increasing burden of disease from hepatitis A, and may benefit from new or expanded vaccination programs. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Hepatitis B vaccines.

            (2009)
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              Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there?

              Abstract Introduction: Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. Discussion: Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. Conclusions: The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.
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                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                6 November 2018
                6 November 2018
                : 6
                : 13
                : 589-599
                Affiliations
                Drug Health, Western Sydney Local Health District, North Parramatta NSW 2151, Australia. meryemjefferies@ 123456gmail.com
                Westmead Institute for Medical Research, Westmead Hospital, Sydney Medical School University of Sydney, Westmead NSW 2145, Australia
                National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, the Children’s Hospital at Westmead, and the Discipline of Child and Adolescent Health, Sydney Medical School, Westmead, NSW 2145, Australia
                Drug Health, Western Sydney Local Health District, North Parramatta NSW 2151, Australia
                Croydon University Hospital NHS Trust, Croydon SE23 2SP, United Kingdom
                Author notes

                Author contributions: Jefferies M conducted literature search, sifted the titles, identified full texts, created the content, abstracted the data wrote the first version of the manuscript, reviewed the references, completed final revision of the manuscript; Rauff B helped with literature search and revision of the manuscript; Rafiq S updated the figures, prepared video record; Rashid H and Lam T provided study concept and critical revision of the manuscript.

                Correspondence to: Meryem Jefferies, PhD, Senior Scientist, Drug Health, Western Sydney Local Health District, North Parramatta NSW 2151, Australia. meryemjefferies@ 123456gmail.com

                Telephone: +61-437-874156

                Article
                jWJCC.v6.i13.pg589
                10.12998/wjcc.v6.i13.589
                6232563
                30430114
                809d2734-4e7a-4469-8177-b920d219b5aa
                ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 29 May 2018
                : 7 September 2018
                : 16 October 2018
                Categories
                Minireviews

                cirrhosis,global epidemiology,outreach clinic,liver cancer,vaccination,viral hepatitis

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