Strengthening hepatitis B and C surveillance in Europe: results from the two global hepatitis policy surveys (2013 and 2014)
Tóm tắt
Hepatitis B and C are major public health threats in the World Health Organization (WHO) European Region. Viral hepatitis surveillance shortcomings have resulted in many WHO Member States having insufficient data available to guide decision-making. This study describes surveillance in the region based on a quantitative sub-analysis of findings from the 2013 WHO viral hepatitis policy report and a qualitative analysis of civil society survey responses associated with these findings. Descriptive statistics were created from information that national government focal points for viral hepatitis in 44 countries had previously reported in response to the WHO survey. Bivariate analysis was performed to compare data from within and outside of the European Union/European Economic Area (EU/EEA). Survey responses from civil society organizations in the countries of the WHO European Region were collated, and a descriptive analysis of the comments on surveillance-related questions was performed to identify key themes. The response rate for the survey of governments was 83 % among both EU/EEA countries (25/30) and non-EU/EEA countries (19/23). More than 90 % of governments reported having national surveillance systems for the acute forms of hepatitis B and hepatitis C, but less than two-thirds reported surveillance for the chronic forms of both diseases. High proportions of governments reported having central registries for the reporting of deaths (96 %) and liver cancer cases (80 %), while less than half reported regularly conducting viral hepatitis sero-surveys. All responding Member States reported having adequate laboratory capacity nationally to support hepatitis outbreak investigations and other surveillance activities. Target populations for sero-surveys most commonly included people who inject drugs (27 %), the general population (25 %), men who have sex with men (20 %) and pregnant women (20 %). Few statistically significant differences were found between EU/EEA and non-EU/EEA countries. Study findings indicated a capacity for robust viral hepatitis surveillance across the WHO European Region, with most countries having important surveillance components in place, but notable weaknesses were also identified. There is an urgent need for countries throughout the region to strengthen their surveillance programs in order to maximize the population-level impact of advances in HBV and HCV prevention and treatment.
Tài liệu tham khảo
GBD 2013 Mortality and Causes of Death Collaborators. Lancet. 2015;385(9963):117–71.
Perz JF, Armstrong GL, Farrington LA, Hutin YJF, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45(4):529–38.
Hope VD, Eramova I, Capurro D, Donoghoe MC. Prevalence and estimation of hepatitis B and C infections in the WHO European Region: a review of data focusing on the countries outside the European Union and the European Free Trade Association. Epidemiol Infect. 2014;142(2):270–86.
Nelson P, Mathers B, Cowie B, Hagan H, Jarlais DD, Horyniak D, et al. The epidemiology of viral hepatitis among people who inject drugs: Results of global systematic reviews. Lancet. 2011;378(9791):571–83.
European Centre for Disease Prevention and Control. Hepatitis C surveillance in Europe – 2013 [Internet]. Stockholm; 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/hepatitis-c-surveillance-in-europe-2013.pdf.
European Centre for Disease Prevention and Control. Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease and screening policies [Internet]. Stockholm; 2010. Available from: http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_C%20_EU_neighbourhood.pdf.
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015. doi:10.1016/S0140-6736(15)61412-X [Epub ahead of print].
Khetsuriani N, Tishkova F, Jabirov S, Wannemuehler K, Kamili S, Pirova Z, et al. Substantial decline in hepatitis B virus infections following vaccine introduction in Tajikistan. Vaccine. 2015;33(32):4019–24.
Chen D-S. Hepatitis B vaccination: the key towards elimination and eradication of hepatitis B. J Hepatol. 2009;50(4):805–16.
World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection [Internet]. Geneva; 2015 [cited 2015 Jul 24]. Available from: http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1&ua=1
Pawlotsky J-M, Feld JJ, Zeuzem S, Hoofnagle JH. From non-A, non-B hepatitis to hepatitis C virus cure. J Hepatol. 2015;62(1 Suppl):S87–99.
World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis C infection [Internet]. Geneva; 2014 [cited 2015 Jan 28]. Available from: http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1.
World Health Organization. Draft global health sector strategy on viral hepatitis, 2016–2021: the first of its kind (draft: 13.11.2015) [Internet]. Available from: http://www.who.int/hepatitis/strategy2016-2021/Draft_global_health_sector_strategy_viral_hepatitis_13nov.pdf?ua=1.
Wiktor SZ. Where next for hepatitis B and C surveillance? J Viral Hepat. 2015;22(7):571–3.
World Health Organization. Prevention and control of viral hepatitis infection: framework for global action. 2012. Available from: http://apps.who.int/iris/bitstream/10665/130012/1/WHO_HSE_PED_HIP_GHP_2012.1_eng.pdf?ua=1&ua=1.
Sixty-third World Health Assembly. WHA63.18 Hepatitis. [Internet]. 2010. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA63-REC1/WHA63_REC1-en.pdf.
Sixty-seventh World Health Assembly. WHA67.6 Hepatitis [Internet]. 2014. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R6-en.pdf.
World Health Organization. Technical considerations and case definitions to improve surveillance for viral hepatitis: technical report [Internet]. 2016 [cited 2016 May 5]. Available from: http://apps.who.int/iris/bitstream/10665/204501/1/9789241549547_eng.pdf?ua=1
World Health Organization. Monitoring and evaluation for viral hepatitis B and C: recommended indicators and framework [Internet]. 2016. Available from: http://apps.who.int/iris/bitstream/10665/204790/1/9789241510288_eng.pdf.
European Centre for Disease Prevention and Control. Hepatitis B and C surveillance in Europe 2012 [Internet]. Stockholm; 2014. Available from: http://ecdc.europa.eu/en/publications/Publications/hepatitis-b-c-surveillance-europe-2012-july-2014.pdf.
Duffell EF, van de Laar MJW, Amato-Gauci AJ. Enhanced surveillance of hepatitis B in the EU, 2006–2012. J Viral Hepat. 2015;22(7):581–9. doi:10.1111/jvh.12364. Epub 2014 Nov 24.
Duffell EF, van de Laar MJW, Amato-Gauci AJ. Enhanced surveillance of hepatitis C in the EU, 2006–2012. J Viral Hepat. 2015;22(7):590–5. doi:10.1111/jvh.12367. Epub 2014 Nov 25.
World Health Organization. Global policy report on the prevention and control of viral hepatitis in WHO Member States. 2013.
World Hepatitis Alliance. Global Community Hepatitis Policy Report [Internet]. London; 2014. Available from: http://www.worldhepatitisalliance.org/sites/default/files/resources/documents/Community%20policy%20report.pdf.
World Health Organization. WHO-recommended standards for surveillance of selected vaccine-preventable diseases. 2003.
European Centre for Disease Prevention and Control. Hepatitis B surveillance in Europe – 2013 [Internet]. Stockholm; 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/hepatitis-b-surveillance-in-europe-2013.pdf.
Committee on the Prevention and Control of Viral Hepatitis Infections; Institute of Medicine. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. [Internet]. 2010. Available from: http://www.nap.edu/catalog/12793.html.
Irving WL, Brown RJP. Acute hepatitis C virus infection: a dynamic-and challenging-concept. J Infect Dis. 2010;202(12):1765–7.
2012/506/EU: Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council [Internet]. 2012. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF.
Manos MM, Leyden WA, Murphy RC, Terrault NA, Bell BP. Limitations of conventionally derived chronic liver disease mortality rates: Results of a comprehensive assessment. Hepatol. 2008;47(4):1150–7.
Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR. Underestimation of liver-related mortality in the United States. Gastroenterology. 2013;145(2):375–382-2.
Aspinall EJ, Hutchinson SJ, Janjua NZ, Grebely J, Yu A, Alavi M, et al. Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment. J Hepatol. 2015;62(2):269–77.
Hatzakis A, Wait S, Bruix J, Buti M, Carballo M, Cavaleri M, et al. The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference*: The state of hepatitis B and C in Europe. J Viral Hepat. 2011;18:1–16.
Kanwal F, Hoang T, Kramer JR, Asch SM, Goetz MB, Zeringue A, et al. Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection. Gastroenterology. 2011;140(4):1182–1188.e1.
Center MM, Jemal A. International trends in liver cancer incidence rates. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2011;20(11):2362–8.
Brogueira P, Costa A, Miranda A, Peres S, Baptista T, Aldir I, et al. Improve screening of HCV infection by targeting high prevalence aged groups: analysis of a cohort of HCV and HIV co-infected patients. J Int AIDS Soc. 2014;17(4 Suppl 3):19601.
European Network for HIV/AIDS Surveillance [website] [Internet]. [cited 2016 Feb 9]. Available from: http://ecdc.europa.eu/en/healthtopics/aids/hiv-network/Pages/index.aspx.
Giesecke J. Modern infectious disease epidemiology. 3rd ed. London: Arnold; 2002.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2013;380(9859):2095–128.