Hepatitis data and statistics in the Western Pacific

Viral hepatitis is one of the major public health threats in the Western Pacific Region. The prevalence of hepatitis B among general population in the region was 5.92% in 2019. Among children under the age of 5 years, the regional prevalence of hepatitis B was 0.46%. Overall, 21/37 countries and areas have achieved the regional target of <1% HBsAg prevalence among children under 5 years of age.

Hepatitis C prevalence was 0.49% among general population in the region in 2019.

The number of new infections and mortality caused by the hepatitis virus is considered a measure of health system responsiveness towards preventing the viral hepatitis and are included as impact indicators to monitor the progress.

●  The incidence of hepatitis B in the region was 140 000, while deaths were estimated to be 470 000 in 2019. 

●  The incidence of hepatitis C in the region was 230 000, while the deaths were  estimated to be  77 000 in 2019. 

Source: WHO 2021 https://www.who.int/publications/i/item/9789240027077

Table 1: Hepatitis B and C in the WHO Western Pacific Region

Reliable epidemiological estimates for hepatitis B and C are not available for many countries in the Region. Presented in this table is estimated prevalence of chronic HBV and HCV in the Western Pacific Region.

HBsAg (2010) and HCV RNA (2017), unless otherwise noted in table

HBsAg - hepatitis B surface antigen
HCV RNA - hepatitis C RNA viral load 
NA - not available

Source:

HBsAg (unless otherwise noted below): Schweitzer A, et al. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546–55.

HCV (unless otherwise noted below): The CDA Foundation. Hepatitis C country profiles. Lafayette, CO: CDA Foundation; 2017 (http://polarisobservatory.org/, accessed 30 October 2017).

Australia: National Surveillance for Hepatitis B Indicators, Measuring the progress towards the targets of the National Hepatitis B Strategy Annual Report 2019, Melbourne, Australia.

Australia: National update on HIV, viral hepatitis and sexually transmissible infections in Australia: 2009–2018, Kirby Institute, Australia.

Fiji: Estimates and projection of disease burden for hepatitis B Fiji, January 2017. 

Malaysia: McDonald S et. al. Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis. BMC Infect Dis. 2014;14:564. A later study by the CDA cites 384 000  (Chan HL et al. The present and future disease burden of hepatitis C virus. J Viral Hepat. 2017;24(Suppl 2):25–43). There is uncertainty in the HCV estimates and further research would be required to better estimate the disease burden.

Mongolia: WHO and MOH Mongolia. Joint mid-term review of the Mongolia Healthy Liver Programme, August 2019.

Philippines: Department of Health Philippines, CDA, WHO. Estimates and projection of disease burden for hepatitis B and C in Philippines, November 2018.

MOH Fiji, CDA, WHO. Estimates and Projection of Disease Burden for Hepatitis B Fiji, January 2017. 

MOH Kiribati, CDA, WHO. Estimates and Projection of Disease Burden for Hepatitis B Kiribati, January 2017. 

MOH Viet Nam. CDA, WHO. Estimates and Projection of Disease Burden for Hepatitis B and C in Viet Nam, June 2017.  

Table 2: Top 10 country ranking: age-standardized incidence rate of liver cancer

Source: IARC 2021 (accessed 18 July 2021: Cancer Today (iarc.fr))

ASR or ge-standardized mortality rate is a weighted average of the age-specific mortality rates per 100 000 persons, where the weights are the proportions of persons in the corresponding age groups of the WHO standard population.

Cirrhosis and liver cancer cause most hepatitis-related deaths

Among the causes attributed to deaths due to hepatitis in 2019, acute hepatitis caused nearly 1% of deaths while 99% were attributed to cirrhosis and liver cancer (49.5% each). Most (72%) acute hepatitis deaths were due to hepatitis B. Hepatitis B and C are the major causes of liver cirrhosis in the Western Pacific region (Figure 1 -3).

Source: IHME 2021 (accessed 25 July 2021: GBD Compare | IHME Viz Hub (healthdata.org)) 

Figure 1: Cause of death due to acute hepatitis, Western Pacific region, 2019

Figure 3: Deaths due to liver cirrhosis and other chronic liver disease, Western Pacific region, 2019

Figure 2: Attributable causes for liver cancer deaths, Western Pacific region, 2019

Figure 4: Regional burden of death due to liver cancer and proportion contributed by countries in the Western Pacific region, 2019 (x1000)

Figure 4: Regional burden of death due to liver cancer and proportion contributed by countries in the Western Pacific region, 2019 (x1000)

Source: WHO Mortality estimates by cause, age and sex, by country, 2000–2019.
(accessed on 18th July 2021: Global health estimates: Leading causes of death (who.int))

Figure 5: Estimated age standardized mortality rate in 2020, men and women due to Liver cancer

Source: IARC 2021 (accessed 20 July 2021:Cancer Today (iarc.fr))
There are more men dying from liver cancer than women. In Mongolia, liver cancer is also the top cancer death among women, as is among men.

 

 

Figure 6: Hepatitis B and C cascade of care: progress against 2020 targets, by regions

Source: WHO 2021

Figure 8: Hepatitis B progress, Western Pacific region,2019

Source: WHO 2021

Figure 7: Hepatitis B and C cascade of care: progress against 2030 targets, by regions.

Source: WHO 2021

Table 3:  Regional hepatitis B and C progress in the Western Pacific Region, 2021

 

± 2015 baseline data was used as the denominator (number of people living with hepatitis C)

PWID: people who inject drugs

Source: WHO, 2021.    

Table 4: Coverage of hepatitis treatment through domestic resources (social health insurance and government financing) at the end of 2020 for selected countries in the Western Pacific Region.

± Papua New Guinea: HBV testing and treatment pilot established in Oro province since 2019.

* Philippines: pilots for hepatitis B (HBV) and C (HCV) testing and treatment started with government financing in 2019, with HBV national expansion in April 2020

Source: WHO Western Pacific Region, 2020.

 

Hepatitis in the Western Pacific

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