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Global HCV 150 Million: reused syringes, IDU, sexual transmission, HIV coinfection, China/India/Pakistan, Africa
  China and India together have an estimated 123 million people chronically infected with HBV and 59 million people chronically infected with HCV, accounting for almost 50 percent of all HBV and HCV infections worldwide.....India is one the fastest growing economies with approximately 25-30 percent of the population living below the poverty line. More than 30 million people in India are infected with HBV and 19 million are infected with HCV.....Approximately 40 million people are infected with HCV in China, which led the Chinese government to declare it as an urgent public healthcare issue
That culprit, identified in 1989, was hepatitis C virus (HCV). Some 130-200 million people are now estimated to be infected worldwide. Rates of transmission in the United States, Europe and Japan have plummeted since the virus was identified, however, thanks to disposable medical instruments and a screened blood supply. But the virus continues to thrive in developing nations, which lack the resources to treat people who do not appear ill. Treatment is expensive, lengthy and causes numerous side effects - and, for all that, it works only about half the time. The upshot is that more than 350,000 people worldwide die from HCV-related liver disease every year2.
Report: about 38 million Chinese carry hepatitis C virus
Nov 22, 2007 - 22 (Xinhua) -- About 38 million Chinese are carrying the hepatitis C virus (HCV), but public understanding of the disease is low
Past Illegal Blood Donation in China Linked to Hepatitis www.natap.org/2005/HCV/102105_03.htm Oct 20, 2005 - Research in a rural province of central China has documented that illegal blood donation practices led to high hepatitis C virus (HCV)
Is sexual contact a major mode of hepatitis C virus transmission ... www.natap.org/2010/HCV/090710_02.htm
Jul 15, 2010 - Division of Viral Hepatitis, National Center for HIV/AIDS, ... HCV by heterosexual contact. cross-sectional study in India showed that men
"The presence of preexisting STIs has also been found to increase the risk of acquiring HCV by heterosexual contact. cross-sectional study in India showed that men infected with herpes simplex virus 2 were almost four times more likely to have HCV than men without herpes simplex virus 2 infection (aOR 3.85, 95% CI 1.18- 12.6). 47 Similarly, individuals with Trichomonas infection were much more likely to acquire HCV than individuals without an STI (aOR 3.3, 95% CI 1.7-6.3)
Reusing Syringes Causes HBV Outbreak in India www.natap.org/2009/newsUpdates/022509_03.htm
Reusing Syringes Causes HBV Outbreak in India. Arrests in India after hepatitis B kills 32. NEW DELHI, India (CNN)
Hepatitis C in India www.natap.org/2003/may/050503_3.htm
Limited information is available about the prevalence and genotype distribution of hepatitis C virus (HCV) in the general population of India
BMS Foundation allots $1 mn to eradicate hepatitis in China, India www.natap.org/2011/newsUpdates/022311_01.htm
BMS Foundation allots $1 mn to eradicate hepatitis in China, India. http://www.biospectrumasia.com. Bangkok, Feb 18, 2011: The Bristol-Myers Squibb
HCV Coinfection Biggest Problem in India
Hepatitis C affects the liver of the patient and the Anti-Retroviral Therapy ... been able to bring to the knowledge of NACO and India Government


HCV/HBV in Pakistan 8%
Jun 29, 2011 - HCV/HBV in Pakistan 8%. PAKISTAN: Health personnel spread hepatitis....."12 million out of a population of 165 million were infected by
HCV is transmitted through the blood, mainly via transfusions, shared needles and reused medical supplies. Sexual and mother-to-child transmission is much less likely than for HIV. In developed nations, most new infections occur in injection-drug users. An estimated 1.6% of the US population carries HCV, as many as three-quarters of whom don't know they have it3. In poorer countries, the reuse of medical supplies is still common and - in combination with a lack of screening of blood donations - is fuelling the virus's spread. Complicating the picture, HCV exists in at least eleven variations or at lest six genotypes, and treatment success varies by genotype. (see 'Spread of HCV').
Different countries confront distinct challenges when dealing with the HCV epidemic. The Egyptian healthcare system, for instance, has to cope with the highest rate of transmission in the world, at least 14% of Egypt's citizens infected - three times the global infection rate (see 'A uniquely Egyptian epidemic', page S12). Elsewhere, severity of the HCV epidemic is obscured by other, more immediately severe public health concerns. Throughout much of Africa, HCV 'hides behind' widespread HIV and hepatitis B virus infections, says virologist Jean-Michel Pawlotsky, director of the French National Reference Center for Hepatitis B, C and delta. On a recent visit to a country in southern Africa, Pawlotsky noticed that they screen blood for HIV and hepatitis B but that "they don't have the resources" to screen for HCV.
"All countries share a few common challenges with hepatitis C," says John Ward, director of the viral hepatitis program at the US Centers for Disease Control and Prevention. "One is a very low level of awareness of the severity of the problem - clinician knowledge of HCV seems to be inadequate no matter what country you're in."
In France, where politicians were found guilty of distributing HIV-contaminated blood in the mid-1980s, officials are now trying to prevent a repeat with HCV. French public-health workers have been screening the populace intensively for HCV, and the French government estimates that it has identified 60% of the country's infected citizens, Pawlotsky says. "Half of those have been treated, and half of those treated have been cured." Which, he says, means that "with the heaviest campaign worldwide and the largest proportion of screened patients, we have only cured twelve to fifteen percent" of those infected nationwide.
Viral hepatitis in India.
Natl Med J INdia

Viral hepatitis is a major public health problem in India, which is hyperendemic for HAV and HEV. Seroprevalence studies reveal that 90%-100% of the population acquires anti-HAV antibody and becomes immune by adolescence. Many epidemics of HEV have been reported from India. HAV related liver disease is uncommon in India and occurs mainly in children. HEV is also the major cause of sporadic adult acute viral hepatitis and ALF. Pregnant women and patients with CLD constitute the high risk groups to contract HEV infection, and HEV-induced mortality among them is substantial, which underlines the need for preventive measures for such groups. Children with HAV and HEV coinfection are prone to develop ALF. India has intermediate HBV endemicity, with a carrier frequency of 2%-4%. HBV is the major cause of CLD and HCC. Chronic HBV infection in India is acquired in childhood, presumably before 5 years of age, through horizontal transmission. Vertical transmission of HBV in India is considered to be infrequent. Inclusion of HBV vaccination in the expanded programme of immunization is essential to reduce the HBV carrier frequency and disease burden. HBV genotypes A and D are prevalent in India, which are similar to the HBV genotypes in the West. HCV infection in India has a population prevalence of around 1%, and occurs predominantly through transfusion and the use of unsterile glass syringes. HCV genotypes 3 and 2 are prevalent in 60%-80% of the population and they respond well to a combination of interferon and ribavirin. About 10%-15% of CLD and HCC are associated with HCV infection in India. HCV infection is also a major cause of post-transfusion hepatitis. HDV infection is infrequent in India and is present about 5%-10% of patients with HBV-related liver disease. HCC appears to be less common in India than would be expected from the prevalence rates of HBV and HCV. The high disease burden of viral hepatitis and related CLD in India, calls for the setting up of a hepatitis registry and formulation of government-supported prevention and control strategies.
Seroepidemiology of HBV and HCV in India. Strategy for control of maternal transmission of HBV and its effect. Screening methods of blood donors for control of post-transfusion hepatitis and their effects
International Hepatology Communications Volume 5, Issue 1, May 1996
The HBV prevalence rate in India is 2-8 percent with an approximate carrier pool of 36 million. India being a large country, the HBV carrier and infection rate varies in different regions of the country. HBV prevalence is highest in South India (5.5%). The high risk population for HBV carrier state as well as for HBV infection includes professional blood donors (10-11%), patients undergoing hoemodialysis (65.8%), residential population of orphanage (15.3%), and parenteral drug abusers (8.5%). Medical and paramedical personnel dealing with dental surgery, and truck drivers in North India also carry a higher HBV prevalence. Vertical or perinatal transmission of HBV in India, unlike in South-East Asia, is infrequent due to a low HBeAg positivety rate (7.8%) among pregnant females with HBV infection. On the other hand, horizontal transmission in early childhood due to crowded and unhygienic living conditions is the major role of spread for HBV infection in India. Amongst adults, transfusion of blood collected from professional blood donors constitutes another important mode of HBV transmission. HBV is an important cause of liver disease in India and is responsible for 42% of acute hepatitis, 33% of acute liver failure, 34% of subacute liver failure, 68% of chronic hepatitis, 80% of cirrhosis and 61% of Hepatocellular carcinoma. HCV related liver disease is infrequent and anti HCV antibody positivity rates are low in the general population (0.9%). HCV antibody positivity in patients with chronic liver disease is approximately 13%. At present there is no national strategy for HBV prevention in India and motivated clinicians are making individual efforts to promote HBV immunization. Post transfusion hepatitis related to professional blood use continues to be an important cause of HBV and HCV related liver disease in India. Screening of blood for HBsAg and anti HCV antibody needs to be widely practised to control the frequency of transfusion related liver disease in India.
Hepatitis Takes Toll on Millions: New Public Health Concern New Report Warns Government to Change Focus www.christianpost.com/news
A fresh look at hepatitis outbreaks across the globe show the number of those infected with the disease is skyrocketing among drug abusers. The new discovery has prompted an outcry among health advocates warning that governments must tackle the stigma and discrimination associated with the disease or the effort to save millions of lives will be wasted.
Hepatitis C is the most common chronic blood borne infection in the United States, according to the Centers for Disease Control and Prevention. Researchers, working on a new global health report for the World Health Organization and the U.S. National Institutes of Health, reported last week there are more drug users infected with hepatitis than previously thought because much of the research focus is directed toward HIV.
Their report warns that the growing number of hepatitis cases has created a new threat to public health.
"Maintenance and strengthening of the response to HIV in injecting drug users remains crucial, but the significance of viral hepatitis needs to receive greater attention than it does at present," according to the National Drug and Alcohol Research Centre at the University of New South Wales.
The first worldwide report on the disease reveal that ten million drug users are infected with hepatitis C, while 1.3 million have hepatitis B.
Breaking it down, new reports show numbers of those diagnosed with hepatitis in the largest populations are increasing daily. Today, there are 1.6 million infected in China, about 1.5 million in the United States, and 1.3 million in Russia, according to medical researchers published in The Lancet medical journal.
Medical experts say only a fraction of those infected are receiving antiviral drugs. This is mainly because many do not know they have the disease.
Those who are advocating for change in the perceptions associated with hepatitis say governments must start delivering better improvements in awareness, surveillance, prevention, and diagnosis and treatment of viral hepatitis.
The World Hepatitis Alliance also published research this week that found less than one third of all governments fund action to reduce the stigma and discrimination against people living with hepatitis.
Another report by the Australian Institute of Health shows that the levels of risky alcohol use remain unchanged as illicit drug use has increased.
Heroin continues to be the drug most associated with "a drug problem," followed by cannabis. But there was also a small rise in community tolerance of regular cannabis use, researchers said.
"The high numbers of those infected with hepatitis is largely attributable to needle sharing during the 1970s and 1980s, before the risks of blood borne viruses were widely known and before educational initiatives were implemented," the CDC said in a statement.
It can also spread through sex with an infected person and from mother to baby during childbirth.
Hepatitis viruses come in five forms: A, B, C, D and E. Hepatitis D and E are less common, according to the CDC.
Sixty to 70 percent of those newly infected with hepatitis typically are usually asymptomatic or have a mild clinical illness.
In many cases, hepatitis has no symptoms, so infected people pass it onto others without knowing. About 80,000 new infections occur each year in the United States, according to the CDC.
The majority of infected persons might not be aware of their infection because it mimics a typical illness and the continued stigma attached to the disease prompts secrecy resulting in no treatment.
However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other hepatitis-related chronic diseases decades after infection.
Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. Consumption of fecal contaminated drinking water has given rise to recent epidemics, and the ingestion of raw or uncooked shellfish has been the source of sporadic cases across the world. About 40 million people in India are infected with Hepatitis B and the risk of its transmission is hundred times more than that of the dreaded HIV, health officials warned this week.
Chronically infected people are at high risk of death from cirrhosis of the liver and liver cancer.
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