World Hepatitis Day is on July 28th, marking the birthday of Dr Baruch Blumberg, the Nobel-prize winning scientist who discovered HBV and developed a diagnostic test and initial vaccine. The theme for World Hepatitis Day 2022 is “Bringing hepatitis care closer to you”, with calls for simplified service delivery.
According to the WHO, a patient dies every 30 seconds from hepatitis B or C. Although Hepatitis B kills more people each year than AIDS-related illnesses, an effective vaccine does exist. Four years after the 1965 discovery of the virus in 1965 Drs Blumberg and Millman developed a heat-treated vaccine. In 1981 the FDA approved a plasma-derived vaccine, involving the collection of blood from infected donors, since discontinued. In 1986 fresh research resulted in a second generation of DNA recombinant vaccines. These are synthetically prepared and approved in the United Sates. Looking at the different strains of hepatitis we can explore the vaccination options available across the world.
- Hepatitis A: there are several inactivated vaccines available to people over the age of 1. In China a live-attenuated vaccine is also available.
- Hepatitis B: the WHO recommends that infants receive the current vaccine, a protein-based subunit vaccine that contains the HBV surface antigen, immediately after birth. This protection lasts at least 20 years, possibly for life. This initial dose coverage is relatively low, at 43% globally. The key issue here is accessing mothers whose births are not supervised by medical professionals. However, there was a significant increase in the number of children getting all three doses from 1990, around 1%, to 2019, closer to 85%. This has reduced transmission in early years but is globally unequal. In 2019 around 296 million people were living with chronic hepatitis B, with 1.5 million infections a year.
- Hepatitis C: there is currently no effective vaccine, so prevention relies on reduced exposure to the virus in healthcare settings and high-risk populations, including those who inject drugs. Described by Dr Jeffrey Glenn of Stanford University as a “huge problem” HCV faces little opposition from current treatments, which are often toxic, he said. *
- Hepatitis D: protection can largely be found in the HBV vaccine unless the patient already has HBV. A recent paper by Dr Glenn suggested that the HBV vaccinations played a significant role in reducing HDV infection in certain areas, alongside factors like “socioeconomic improvements”.
- Hepatitis E: there is a vaccine, but it is only licensed in China.
Going forward, the WHO has set the following targets to achieve hepatitis elimination by 2030:
- Reduce new infections of hepatitis B and C by 90%
- Reduce hepatitis related deaths from liver cirrhosis and cancer by 65%
- Ensure that at least 90% of hepatitis B and C positive patients are diagnosed
- Enable 80% of those eligible to receive appropriate treatment
- How can the vaccines industry contribute to these targets, and is it likely that they can be achieved in time?
*To see Dr Jeffrey Glenn and other industry experts at the World Antiviral Congress in November head here to get your tickets.