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Strategies to prevent and control hepatitis B and C virus infections: a global perspective
E E Mast1, M J Alter, H S Margolis
1Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30306, USA. eem1@cdc.gov
Insights
Hepatitis B virus (HBV) and hepatitis C virus (HCV) cause significant liver disease globally. Prevention strategies differ, with HBV vaccination and HCV risk reduction being key.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are leading causes of acute and chronic liver disease worldwide.
- Chronic infections can progress to cirrhosis and hepatocellular carcinoma.
- Both are bloodborne pathogens with distinct transmission routes.
Purpose of the Study:
- To outline global prevention and control strategies for HBV and HCV.
- To highlight differences in transmission and prevention based on country-specific epidemiology.
- To emphasize the importance of primary prevention for HCV due to the lack of a vaccine.
Main Methods:
- Review of transmission modes for HBV and HCV.
- Analysis of effective prevention strategies for HBV, including vaccination and nosocomial transmission control.
- Discussion of primary prevention for HCV, focusing on reducing exposure risks.
Main Results:
- HBV is transmitted via percutaneous and mucosal routes; HCV predominantly via percutaneous exposure.
- Effective HBV prevention includes perinatal transmission control, vaccination, and preventing nosocomial spread.
- HCV prevention is challenging without a vaccine, necessitating focus on reducing transmission via unsafe practices and blood transfusions.
Conclusions:
- Tailoring prevention strategies to local HBV and HCV epidemiology is crucial.
- Comprehensive HBV prevention involves vaccination and infection control.
- Reducing HCV transmission requires stringent primary prevention measures targeting high-risk exposures.
Abstract:
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of acute and chronic liver disease worldwide. Chronic infection with these viruses often leads to chronic liver disease, including cirrhosis or primary hepatocellular carcinoma. Both HBV and HCV are bloodborne viruses; however, HBV is transmitted efficiently by both percutaneous and mucosal exposures, and HCV is transmitted predominantly by percutaneous exposures. Because the relative importance of various modes of transmission of these viruses differs by country, the choice of specific prevention and control strategies depends primarily on the epidemiology of infection in a particular country. Comprehensive hepatitis B prevention strategies should include (1) prevention of perinatal HBV transmission, (2) hepatitis B vaccination at critical ages to interrupt transmission and (3) prevention of nosocomial HBV transmission. The prevention of hepatitis C is problematic because a vaccine to prevent HCV infection is not expected to be developed in the foreseeable future. From a global perspective, the greatest impact on the disease burden associated with HCV infection will most likely be achieved by focusing efforts on primary prevention strategies to reduce or eliminate the risk for transmission from nosocomial exposures (e.g. blood transfusion, unsafe injection practices) and high-risk practices (e.g. injecting drug use).