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Symposiums

S5.1 Supporting Global Hepatitis Health Sector Strategy 09:00 Convention Hall C

Current Situation of Viral Hepatitis in Hong Kong
Tsang OTY
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
Viral hepatitis is a major public health challenge. It caused 1.34 million deaths in 2015. Despite the success in lowering HOSPITAL AUTHORITY CONVENTION 2018
fatalities of many infectious diseases including HIV, the number of deaths resulted from viral hepatitis, primarily chronic
hepatitis B (CHB) and C (CHC), is still on the rise. It was estimated that about 257 million people living with chronic hepatitis B
and 71 million people with chronic hepatitis C globally in 2015.

In 2016, the World Health Organization has called for elimination of viral hepatitis as a public health threat by 2030, aiming to
reduce new infections by 90% and mortality by 65%. In fact, implementation of hepatitis B vaccination in many countries has
significantly reduced the transmission in children. A substantial reduction in prevalence of hepatitis B was also noted after
the introduction of vaccination in 1988 in Hong Kong. The prevalence of hepatitis B surface antigen (HBsAg) positivity among
new blood donors dropped from 8% in 1990 to 0.8% in 2016. The situation was even more prominent among the young
donors aged 16-19 with a prevalence of only 0.3%. The HBsAg prevalence among the antenatal mothers was also lowered
from 11.3% in 1990 to 5.2% in 2016. Higher prevalence was observed in pregnant women born in mainland China. The
prevalence in high risk cohorts, like HIV infected patients, patients with tuberculosis infection and intravenous drug users,
was still persistently higher than other cohorts.

Chronic hepatitis C infection, nevertheless, is not common in Hong Kong. It was found in only 0.04 to 0.1% of new blood
donors. However, the prevalence could be more than 40% in intravenous drug users and more than 10% in patients with
distant history of blood transfusion. The introduction of antivirals for the treatment of CHB and CHC has significantly reduced
the incidence of late-stage cirrhosis and hepatocellular carcinoma. However, there are still major challenges on the road of
hepatitis eradication. The local hepatitis registry is inadequate to anticipate the scope of the problems. All existing data are
based on surveillance on different cohorts. Hepatitis awareness and screening need further boosting. Silent transmissions
are still going on, especially in high risk individuals. The treatment policy for hepatitis is essentially resource-driven instead
of being based upon scientific evidence. Assessment of the degree of liver inflammation and fibrosis may not be timely
enough to justify early drug treatment, as a result of the limitation in resources and manpower. For the same token, some of
the medications which have been obsoleted in many developed countries are still in use as the first-line candidate for the
treatment of hepatitis.

Having said that, eradication of hepatitis B and C can still be achievable with determination of the government, as well as the
facilitation and enhanced monitoring of both screening and treatment at different levels.

S5.2 Supporting Global Hepatitis Health Sector Strategy 09:00 Convention Hall C

The Future of Viral Hepatitis Testing: Innovations and Testing Technologies and Approaches
Peeling R
Clinical Research, London School of Hygiene and Tropical Medicine, UK
A large burden of undiagnosed hepatitis virus cases remains globally. Despite the documented 240 million people living with
chronic hepatitis B virus (HBV) infection, 110 million identified as hepatitis C virus (HCV) antibody positive and 80 million with
chronic viraemic HCV infection. The majority of the disease burden of hepatitis is in the developing world, where less than
1% of the population is aware of their infection. The World Health Organization (WHO) has set an ambitious set of targets to
reduce the incidence of chronic hepatitis infection from the current 6 –10 million cases to 0.9 million infections, and to reduce Tuesday, 8 May 2018
the annual deaths from chronic hepatitis from 1.4 million to less than 0.5 million by 2030. To reach these targets, countries will
require a radical change in their hepatitis response, including strengthening health and community systems to deliver high-
quality services to achieve equitable coverage, improved efficiencies and embracing innovation for acceleration.

In 2016, WHO developed testing guidelines for HBV and HCV. Advances in rapid detection technology have created new
opportunities for enhancing access to screening and referral, as well as monitoring of treatment. This presentation examines
a range of technological innovations associated with simplified and more affordable testing algorithms for HBV and HCV
testing, including treatment monitoring, improved access to testing through self-testing of oral fluids, dried blood spots
and point-of-care molecular assays. Multiplex and polyvalent platforms can be leveraged for use with HIV, HBV and HCV.
Innovations in delivery through data connectivity and use of unmanned aerial vehicles to transport tests and dried blood
spots and other supplies will allow expanded services to remote areas.

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