dr jojo go hep b liver ca summit

Office of the WHO Representative in the Philippines

Global Burden of Hepatitis and Liver CancerGlobal Burden of Hepatitis and Liver Cancer

Philippine Hepatitis and Liver Cancer Summit 2014Shangrila Hotel, Makati City

4 February 2014

Office of the WHO Representative in the Philippines

Noncommunicable Diseases (NCDs)

•Heart diseases and strokes

•Cancers•Diabetes•Chronic respiratory diseases

36M deaths each year due to NCDs…

Office of the WHO Representative in the Philippines

Global Burden of Cancer• Cancer is the world’s second biggest killer after

cardiovascular diseases.• It kills around 8.2 million people globally each year.

65% (5.3 million) of the cancer deaths occurred in les developed regions, with huge implications on human suffering, health systems, health budgets, and efforts to reduce poverty.

Office of the WHO Representative in the Philippines

Viral Hepatitis• Viral hepatitis is a group of infectious diseases that affects

hundreds of millions of people worldwide. • Five distinct hepatitis viruses have been identified: A, B, C, D

and E. • Hepatitis B and C are particularly prevalent.• Untreated chronic hepatitis B and C infection can result in

liver cirrhosis and liver cancer. • An estimated 57% of cases of liver cirrhosis and 78% of

cases of primary liver cancer result from HBV or HCV infection.

Global Burden of hepatitis B (HBV) and hepatitis C (HCV)

• 500 million chronically infected– 350 million HBV– 150-170 million HCV

• 1 million deaths per year– 600,000 HBV– 350,000 HCV

• 57% of cirrhosis– 30% HBV– 27% HCV

• 78% of Hepatocellular carcinoma– 53% HBV– 25% HCV

Number of hepatitis deaths, 2010

Chronic Hepatitis B Infection• Children less than 6 years of age who become infected

with the hepatitis B virus are the most likely to develop chronic infections.

• 80–90% of infants infected during the first year of life develop chronic infections.

• 30–50%% of children infected before the age of 6 years develop chronic infections.

• In adults: <5% of otherwise healthy adults who are infected will develop chronic infection;

• 15–25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis.

Office of the WHO Representative in the Philippines

Hepatitis B and C in Philippines

• Estimated 7.3 M (16.7% of adult population) chronically infected with BHV

• Around 2.3% or 1 M Filipinos may be infected with HCV

» Source: Hepatology Society of thePhilippines, 2013

Office of the WHO Representative in the Philippines

Why should we be concerned about viral hepatitis?

• Millions of people are living with viral hepatitis and millions more are at risk.

• Most people who were infected long ago with HBV or HCV are unaware of their chronic infection. They are at high risk of developing severe chronic liver disease and can unknowingly transmit the infection to other people.

• Viral hepatitis places a heavy burden on the health care system because of the costs of treatment of liver failure and chronic liver disease.

• Some groups are at more risk of contracting viral hepatitis than others.

Office of the WHO Representative in the Philippines

Liver CancerEstimated Incidence, Mortality and Prevalence Worldwide in 2012

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Risk Factors for Liver Cancer• Chronic Viral Hepatitis B and C – most common risk

factor• Cirrhosis• Heavy alcohol use• Aflatoxin• Obesity• Type 2 Diabetes• Tobacco Use• Gender: Male• Race/ Ethnicity

Office of the WHO Representative in the Philippines

• 2010 World Health Assembly resolution 63.18:– Call for comprehensive approach to hepatitis prevention

and control

• Mandate to WHO:– Develop guidelines and strategies for surveillance,

prevention and control of viral hepatitis– Support development of scientific research– Improve global prevalence and disease-burden estimates– Mobilize support– Strengthen WHO Safe Injection Global Network

Framework for global action• Vision:

– A world where viral hepatitis transmission is stopped and all have access to safe and effective care and treatment.

• Axes: – Axis 1: Raising awareness,

promoting partnerships and mobilizing resources

– Axis 2: Evidence-based policy and data for action

– Axis 3: Prevention of transmission

– Axis 4: Care and Treatment

Monitoring the Response: the 2012 Survey

• Baseline survey• Provided information relating to

the four axes of he WHO strategy

• Will be carried out every one to two years to monitor overall progress in implementation

Office of the WHO Representative in the Philippines

WHO Regional Goals to prevent HepB through VACCINATION

2003: the WHO Region agreed to set targets for HepB control though vaccination

2005: the Region adopted targets: Milestone: reduce chronic HB prevalence to <2% in children

at least 5 years old by 2012 Goal: <1% prevalence, target year to established

2013: the Region decided the <1% prevalence target as 2017

World Hepatitis Day (28 July)

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

How WHO Fights Cancer

• Backed by the World Health Assembly resolution 58.22 of 2005 on cancer prevention and control, WHO is committed to a Global Action Plan Against Cancer to reduce the cancer burden worldwide.

The WHO Global NCD Action Plan 2013-2020

Vision:A world free of the avoidable burden of NCDs

Goal:To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels

Office of the WHO Representative in the Philippines

WHO Framework Convention on Tobacco Control (FCTC)

Quitting tobacco is the best way to reduce cancer. To help make this happen, WHO develops and helps implement powerful tobacco controls.

Office of the WHO Representative in the Philippines

WHO Global Strategy on Diet, WHO Global Strategy on Diet, Physical Activity and HealthPhysical Activity and Health

• Eating well and staying active are keys to leading healthier lives and eliminating the risks of chronic conditions like cancer.

• WHO works with countries to craft straightforward approaches to promote healthy diets and physical activity.

Office of the WHO Representative in the Philippines

Global Strategy on Harmful Use of Global Strategy on Harmful Use of AlcoholAlcohol

•WHO works with governments to introduce policies that reducethe negative health consequences of hazardous and harmful alcohol use, identify risky drinking patterns and improve public health.• In 2005, the World Health Assembly adopted a resolution on“public health problems caused by harmful use of alcohol,” urging countries to develop, implement and evaluate effective strategies to reduce the health and social problems associated with alcohol.

Office of the WHO Representative in the Philippines

Immunization Drives Against Immunization Drives Against Hepatitis BHepatitis B

• WHO promotes the introduction of hepatitis B vaccine in many poor countries.

• WHO estimates more than 2 million child deaths were averted through immunization in 2003, plus another 600 000 hepatitis B- related deaths that would have occurred in adulthood from liver cancer and cirrhosis.

Condition Interventions

Tobacco use Tax increases; smoke-free indoor workplaces & public places; health information / warnings; advertising/promotion bans

Alcohol use Tax increases; restrict retail access; advertising bans

Unhealthy diet & physical inactivity

Reduced salt intake; replacement of trans fat; public awareness about diet & physical activity

CVD & diabetes Counselling & multi-drug therapy (including glycaemic control for diabetes) for people with >30% CVD risk

(including those with CVD); treatment of heart attacks with aspirin

Cancer Hepatitis B immunization to prevent liver cancer; screening & treatment of pre-cancerous lesions to prevent cervical

cancer

NCD “best buys”

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Thank you

Office of the WHO Representative in the Philippines

Population-wide Interventions: on Cancer Prevention

• Vaccination against Hepatitis (BEST BUY)• HPV vaccination• Protection against environmental or

occupational risk factors for cancer, such as aflatoxin, asbestos and contaminants in drinking-water

• Screening for breast and cervical cancer

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines