It's no secret that malaria, tuberculosis, and HIV are among the deadliest maladies on the planet. But there's another condition that exacts an even larger death toll and yet receives far less attention.
That condition is viral hepatitis, which claims 1.5 million lives a year. Most people who are infected don't even know it.
Fortunately, our understanding of viral hepatitis—especially that caused by the hepatitis C virus—has advanced greatly in recent years. In many cases, we can treat and even cure hepatitis. But we can't deploy these new treatments and cures unless we identify those who are infected. That will require public health leaders to scale up their screening efforts and embrace new diagnostic tools.
Unfortunately, hepatitis is becoming a bigger problem. According to one study from The Lancet, a medical journal, global viral hepatitis deaths increased between 1990 and 2013. In the United States, the number of reported acute hepatitis C cases more than tripled from 2010 to 2016.
A big part of the problem is that most people don't realize they've been infected. Often, people with hepatitis don't exhibit any symptoms. So they don't even think to get tested. Two in three of those with the hepatitis B virus, and half with the hepatitis C virus, are unaware they're infected. In the meantime, they may unknowingly transmit the virus to others.
Infection rates are particularly high in low- and middle-income countries, which often struggle to screen for hepatitis infection. A World Health Organization study examining testing programs in 19 countries found that most didn't focus on large-scale routine testing.
Even in the United States, too few people are screened. The Centers for Disease Control and Prevention recommend that all baby boomers get tested for hepatitis C; less than 13% have done so.
Recently, the World Health Organization issued guidelines recommending that everyone with hepatitis C—including those with advanced forms of the condition—start treatment. But to start treatment people must first know that they are infected. Therefore, we must do a better job screening for hepatitis.
A program in New York City targeted foreign-born individuals, who are typically at a higher risk of infection but lack healthcare coverage or linkage to care. Several medical organizations worked together to publicize testing on radio and television, educate the public about the condition, and provide screenings at community events.
In all, more than 1,600 people were tested. More than seven in 10 people who were diagnosed with the condition and received an evaluation began treatment.
To aid these efforts, medical researchers are developing better diagnostics. Abbott, the company I work for, has tools outside the U.S. to screen for the hepatitis C virus. The HCV core antigen test can confirm active infection from a single patient sample during one doctor's visit.
Thanks to this test, patients diagnosed with hepatitis C infection can be diagnosed with one blood draw and receive a quick consultation. Once they start treatment, 95% can be cured in a few months.
Technologies like this one are helping to save lives. In 2015, public and private-sector researchers from both the United States and the Republic of Georgia began investigating the best ways to screen and treat patients in the small central Eurasian country, where 150,000 people are infected with hepatitis C. After the first year of the program, 32,000 people had completed treatment, and 98%t of them were cured.
Individuals also have a role to play in combating hepatitis by getting tested. Routine bloodwork typically does not screen for hepatitis C, so people should ask their doctors if getting tested is right for them.
The World Health Organization wants to eliminate hepatitis by 2030. Fortunately, we have the tools—the medicines and the diagnostics—to help meet that goal. Now we must use them.
Gavin Cloherty, Ph.D., is director of infectious disease research for Abbott.