Protocol for surveillance of the fraction of cirrhosis and hepatocellular carcinoma attributable to viral hepatitis in clinical centres of excellence
Need for national mortality estimates
The “mortality envelope” from cirrhosis and hepatocellular carcinoma is attributed to HBV and HCV on the basis of evidence from published studies that reported the proportion of patients with these sequelae who had HBV and HCV infection (which is referred to as “the attributable fraction”). At the national level, however, most countries lack a systematic process to generate national estimates of mortality from viral hepatitis. Thus, countries need to institutionalize methods that have been used in an ad-hoc manner in the past for published studies and turn these into a routine surveillance system. To generate national estimates of hepatitis-related mortality, it is necessary (i) to estimate mortality from chronic liver disease (including cirrhosis and hepatocellular carcinoma), and (ii) to estimate the fraction of these conditions that are attributable to various hepatitis viruses. For the first step, national mortality data are usually available. Alternatively, in countries where the quality of data from vital registration systems is not optimal, estimates regarding mortality from cirrhosis and hepatocellular carcinoma are available from WHO or the GBD. However, for the second step, most countries lack a system to estimate which proportion of the sequelae is attributable to the various hepatitis viruses and which due to other causes (e.g. alcohol, metabolic syndrome), and consolidate data from various sources in order to estimate mortality.
The “mortality envelope” from cirrhosis and hepatocellular carcinoma is attributed to HBV and HCV on the basis of evidence from published studies that reported the proportion of patients with these sequelae who had HBV and HCV infection (which is referred to as “the attributable fraction”). At the national level, however, most countries lack a systematic process to generate national estimates of mortality from viral hepatitis. Thus, countries need to institutionalize methods that have been used in an ad-hoc manner in the past for published studies and turn these into a routine surveillance system. To generate national estimates of hepatitis-related mortality, it is necessary (i) to estimate mortality from chronic liver disease (including cirrhosis and hepatocellular carcinoma), and (ii) to estimate the fraction of these conditions that are attributable to various hepatitis viruses. For the first step, national mortality data are usually available. Alternatively, in countries where the quality of data from vital registration systems is not optimal, estimates regarding mortality from cirrhosis and hepatocellular carcinoma are available from WHO or the GBD. However, for the second step, most countries lack a system to estimate which proportion of the sequelae is attributable to the various hepatitis viruses and which due to other causes (e.g. alcohol, metabolic syndrome), and consolidate data from various sources in order to estimate mortality.
Continue reading: http://www.who.int/hepatitis/topics/hepatitis-c/hepatitis-surveillance-protocol-2018/en/
WHO Press Release
WHO calls for better monitoring of viral hepatitis and liver cancer18 March 2018, New Delhi – WHO is sharing a new surveillance protocol to improve understanding of the link between viral hepatitis and its 2 main consequences: cirrhosis and hepatocellular carcinoma (a key type of liver cancer).
Viral hepatitis B and C infections lead to an estimated 1.34 million deaths every year. Most of these deaths are caused by untreated chronic hepatitis infections resulting in cirrhosis and liver cancer. In fact, chronic hepatitis B and C infections are thought to be responsible for about 2 thirds of all cases of liver cancer globally.
However, existing national monitoring systems do not collect death reports with sufficient detail to measure the exact gravity of this important cause of mortality. In national statistics systems, cirrhosis and hepatocellular carcinoma/liver cancer are provided as the causes of death without attribution to the original cause – viral hepatitis.
WHO shared the new protocol today at the Congress of the Asian Pacific Association for the Study of the Liver. It will be implemented at a network of clinics ("centres of excellence") where hepatologists, gastroenterologists and other health-care providers treating cirrhosis and hepatocellular carcinoma patients can start documenting mortality causes and other data more accurately. Their improved documentation will contribute to obtaining more accurate data on the scope of the problem at regional and global levels.
Better understanding of the linkages between viral hepatitis and liver cancer will be key to improving global and national policies and strategies to reduce deaths caused by both diseases.
In 2016, the World Health Assembly endorsed a resolution calling for the elimination of viral hepatitis as a public health threat by 2030. Elimination is defined as a 90% reduction in new cases and a 65% reduction in mortality. By unveiling the link between viral hepatitis and its deadly consequences, the new protocol will help assemble more accurate data to guide progress towards the elimination goal.
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