世卫组织鼓励各国为减少病毒性肝炎死亡立刻行动起来
2016/7/27 北京地坛掌上健康

    

     在7月28日世界肝炎日到来前夕，世卫组织敦促各国快速行动起来，更好地了解这一疾病并加大获取检测和治疗服务。目前，每20名病毒性肝炎感染者中仅有1人知晓感染情况，每100名患者中仅有1人得到治疗。

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    陈冯富珍博士世界卫生组织总干事“这个世界漠视肝炎造成的危害，现在到了对肝炎作出全球应对动员，使产生的应对力度与艾滋病毒/艾滋病和结核病等其它传染病的抗争力度保持相当的时候了。”世界上有4亿人感染乙型和丙型肝炎，这一数字是艾滋病毒携带者人数的10倍以上。2013年，估计有145万人死于这一疾病——而1990年时不足100万。

     在2016年5月召开的世界卫生大会上，194个国家政府通过了史无前例的《全球卫生部门病毒性肝炎战略》，并对首次提出的全球目标达成了一致。这一战略包括到2020年治疗800万乙型或丙型肝炎患者。其长远目标是到2030年在2016年数据的基础上将新发病毒性肝炎感染减少90%并将病毒性肝炎引起的死亡数减少65%。

     这是一项雄心勃勃的战略，不过人们已经握有用来实现这些目标的工具。在乙型肝炎方面已有有效的疫苗和治疗办法。尚没有针对丙型肝炎的疫苗，但在过去几年中有关这一疾病的治疗已经取得了显著进展。采用了被称为直接抗病毒药物的口服药物，这使得在2-3个月内可使90%以上的病人得到治愈成为可能。然而在许多国家，现行政策、规制和药品价格使大多数人的疾病治愈可望不可即。

    

    Gottfried Hirnschall博士世卫组织艾滋病毒/艾滋病司司长和全球肝炎规划主任“我们现在需要行动起来，使人们不再遭受由肝炎导致的不必要死亡，这就要求使所有具有需求的人员迅速加快获得服务和药品。”

    

     改善治疗不过，有些国家正在设法使存有需求的人员获得服务。丙型肝炎药品价格的下降为这些努力带来了便利。现在药品价格正在出现下滑，尤其是那些可以获得非专利药品的国家。2015年，一项初步分析估计，生活在低收入和中等收入国家的30万人已经获得了以新的直接抗病毒药物为基础的丙型肝炎治疗。埃及属于中低收入国家，是世界上丙型肝炎流行率最高的国家之一。该国在过去12个月中治疗了20万人，每位丙型肝炎病人获得治疗的价格从2014年的900美元降到2016年的不足200美元。其它国家加大了针对丙型肝炎的工作力度。巴西和巴基斯坦正在快速扩大治疗覆盖面，格鲁吉亚已经宣布了一项疾病消除计划。

     预防肝炎乙型和丙型肝炎感染是在卫生保健环境以及注射吸毒人员中间通过污染的血液以及通过污染的针头和注射器获得传播的。病毒也可通过不安全性行为传播，并可通过受到感染的母亲传给其新生儿。

     截至2014年，184个国家将为婴儿接种乙肝疫苗作为疫苗接种方案的一部分，这些国家中有82%的儿童接种了乙肝疫苗。这比1992年时的31个国家出现了大幅提升。当年，世界卫生大会通过一项决议，建议在全球范围内接种乙肝疫苗。

     另外，实行血液安全战略，包括对所有捐献的用于输注的血液和血液成分进行有质量保证的筛查，可利于预防乙型和丙型肝炎传播。进行安全注射，消除不必要和不安全的注射，可成为预防传播的有效战略。向注射吸毒者提供减轻危害服务是降低这一人群肝炎感染的关键所在。安全性行为，包括尽量减少 性伴侣的数目并使用屏障保护措施(安全套)等，也可预防传播。

    

     编者按：

     在2016年世界肝炎日，世卫组织、世界肝炎联盟和巴西政府宣布将在2017年3月29-31日在巴西圣保罗举办第二次世界肝炎峰会。

     WHO encourages countries to act now to reduce deaths from viral hepatitis

     Ahead of World Hepatitis Day, 28 July 2016, WHO is urging countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated.

     "The world has ignored hepatitis at its peril,” said Dr Margaret Chan, WHO Director-General. “It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.“

     Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.

    

     In May 2016, at the World Health Assembly, 194 governments adopted the first-ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures.

    

     “We need to act now to stop people from dying needlessly from hepatitis,” said Dr Gottfried Hirnschall, WHO's Director of the HIV/AIDS Department and Global Hepatitis Programme. “This requires a rapid acceleration of access to services and medicines for all people in need.”

     Improving treatmentSome countries, however, are finding ways to get services to the people who need them. These efforts are made easier by the declining price of hepatitis C medicines. Prices are now dropping, particularly in countries that have access to generic drugs. In 2015, a preliminary analysis estimated that 300 000 people living in low- and middle-income countries had received hepatitis C treatment based on the new direct-acting antivirals.

     In Egypt – a lower–middle-income country with one of the world’s highest prevalence rates of hepatitis C – 200 000 people were treated during the past 12 months, and the price of hepatitis C treatment for each person dropped from US$ 900 in 2014 to less than US$ 200 in 2016. Other countries have stepped up efforts against hepatitis C. Brazil and Pakistan are already expanding treatment coverage rapidly, and Georgia has announced a plan to eliminate the disease.

     Preventing hepatitis

     Hepatitis B and C infections are transmitted through contaminated blood as well as through contaminated needles and syringes in healthcare setting and among people who inject drugs. The viruses can also be transmitted through unsafe sex and from an infected mother to her newborn child.

    

     As of 2014, 184 countries vaccinate infants against hepatitis B as part of their vaccination schedules and 82% of children in these states received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

     In addition, implementing blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion, can help prevent transmission of hepatitis B and C. Safe injection practices, eliminating unnecessary and unsafe injections, can be effective strategies to protect against transmission. Harm reduction services for people who inject drugs are critical to reduce hepatitis in this population. Safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission.

    

     Notes for editorsOn World Hepatitis Day 2016, WHO, World Hepatitis Alliance, and the Government of Brazil announce the organization of the Second World Hepatitis Summit to take place in Sao Paulo, Brazil on 29–31 March 2017.

    

    

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