Dr. John Julliard Go National Professional Officer for NCDs World Health Organization WPRO

1. Global Burden of Hepatitis and Liver Cancer
Philippine Hepatitis and Liver Cancer Summit 2014
Shangrila Hotel, Makati City
4 February 2014
Office of the WHO Representative in the Philippines

2. 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

3. 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

4. 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.
Office of the WHO Representative in the Philippines

5. 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

6. Number of hepatitis deaths, 2010

7. 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

8. 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

9. 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

10. Liver Cancer
Estimated Incidence, Mortality and Prevalence Worldwide in 2012
Office of the WHO Representative in the Philippines

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18. Risk Factors for Liver Cancer
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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

19. • 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

20. 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

21. 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

22. 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:
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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

23. World Hepatitis Day (28 July)
Office of the WHO Representative in the Philippines

24. 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.
Office of the WHO Representative in the Philippines

25. 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

26. 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

27. WHO Global Strategy on Diet, Physical
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

28. Global Strategy on Harmful Use of
Alcohol
•WHO works with governments to introduce policies that reduce
the 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

29. Immunization Drives Against
Hepatitis 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 Brelated deaths that would have occurred in
adulthood from liver cancer and cirrhosis.
Office of the WHO Representative in the Philippines

30. NCD “best buys”
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

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34. Thank you
Office of the WHO Representative in the Philippines

35. 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

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