Module 3: HCV prevalence and course of HCV infection - section 1

In this document:

HCV prevalence and public health implications

Activity: Lecture presentation with large group discussion
Section Time: Approximately 20 minutes

The purpose of this section is to help participants gain a perspective on global HCV prevalence, regional, and local variations and the implications for public health.

Introduce this module by presenting Slide 3.2 (Global prevalence of hepatitis C infection) and then Slide 3.3 (European prevalence of hepatitis C infection):

Facilitate a brief discussion:

  • Establish HCV is a widespread global disease; however the maps shown are indicative reflecting data and information availability, rather than disease-based information.
  • Explain that recent estimates of chronic HCV infection range from 140 million to 200 million cases globally but how these estimates are certainly an under-representation of the true rate of chronic HCV infection and related public health burden.

Show Slide 3.4 (The silent epidemic). This is used to help participants reflect that HCV is often described as being a ‘silent’ epidemic.¬†Ask participants to consider the quote from Global State of Harm Reduction, IHRA 2010:

Facilitate a discussion by asking participants to consider:

  • To what extent does this reflect the local situation and experience?
  • What might explain the differences with other countries/regions?
  • To what extent is HCV infection considered a public health issue?
  • What level of HCV awareness is there amongst policy makers, health care professionals, harm reduction services, PWID and those affected?
  • What local responses to HCV treatment and prevention are in place?
  • Is there a need for advocacy for improved epidemiology in line with European standards?
  • Try and establish consensus and understanding on local situation.

Use Slide 3.5 (Hepatitis C and public health burden) to help summarise implications of lack of data:

Facilitate the discussion by:

  • Emphasising that the lack of accurate prevalence data on hepatitis is widely recognised as inhibiting more effective prevention and control at both international and national levels, that this has devastating consequences for people living with HCV (PLWHCV) and PWID.
  • Beginning to consider factors behind limited political commitment such as: the high price of testing and treatment; low awareness of need (relative to HIV) among PWID and PLWHCV with less developed activism and advocacy.
Supporting content:

Following extensive lobbying from the World Hepatitis Alliance and patient groups around the world, in May 2010, the World Health Assembly has agreed a resolution on viral hepatitis that explicitly acknowledges the ‘seriousness of viral hepatitis as a global public health problem’. The resolution was supported by all 193 member states, reflecting the international realisation that action to tackle these diseases is now urgently required and was agreed by WHO Executive Board in January 2011.

In conjunction with a raft of actions designed to stimulate and strengthen hepatitis preventative and controls measure, the resolution urges Member States:

‘To implement and/or improve epidemiological surveillance systems and to strengthen laboratory capacity, where necessary, in order to generate reliable information for guiding prevention and control measures’

(Sixty-third World Health Assembly. May 2010,

HCV is a global disease, widespread, and one that presents an immediate but growing public health crisis. Not every nation in the world has adequate means to survey its population for incidence of the virus and most people have no symptoms in the early stages and are unaware they have been infected, however, enough statistics have been compiled to demonstrate the enormous threat posed by hepatitis C.

Recent estimates of chronic HCV infection range from 140 million to 200 million cases globally - The World Health Organisation estimates that 3% of the world’s population is infected. In comparison the total number of people living with HIV is estimated at around 34 million. However, lack of awareness about HCV is common in many parts of the world, including Eastern Europe and Central Asia and as a result, precise prevalence data are difficult to obtain.

Of the HCV global total, an estimated 10 million people are living with chronic HCV across the former Soviet Union representing about 4% of the overall population in those 15 countries. Prevalence estimates for the United States are slightly less than 2% and Western Europe’s is about 1% or less in each country.

Figures from epidemiological studies in different regions of the world show wide variance in HCV prevalence patterns. Variations within countries are also reported, with inner city urban areas with long established populations of PWID typically having higher rates than those in rural areas. Studies consistently show that the incidence of HCV is higher among less developed nations. The majority of people infected with HCV live in low and middle-income countries.

Chronic viral hepatitis is highly prevalent globally, with some five hundred million people estimated to be currently infected with hepatitis B or C. These two diseases are the cause of significant global mortality and morbidity with approximately 1 million deaths each year attributable to them and their sequelae, liver disease and primary liver cancer.’

(World Hepatitis Alliance, Viral Hepatitis: Global Policy, 2011)

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