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METHODS |
Members of The Global Burden of Hepatitis C Working Group include Yvan Hutin, MD, Mary Ellen Kitler, PhD, FCP, Gregory J. Dore, MD, Joseph F. Perz, DrPH, Gregory L. Armstrong, MD, Geoffrey Dusheiko, MD, Hiromi Ishibashi, MD, Peter Grob, MD, Michael Kew, MD, Patrick Marcellin, MD, Leonard B. Seeff, MD, Philippe Beutels, PhD, Christopher Nelson, MD, Claudia Stein, MD, Pascal Zurn, PhD, Gary Clifford, MD, Robert Vranckx, MD, Alfredo Alberti, MD, Zuhair S. Hallaj, MD, Stephen Hadler, MD, and Daniel Lavanchy, MD.Health Technology and Pharmaceuticals (HTP), Blood Safety and Clinical Technology (BCT), Safe Injection Global Network (SIGN), WHO, Geneva, Switzerland (Dr. Hutin); Communicable Diseases (CDS), Strategy Development and Monitoring for Eradication and Elimination (CEE), Global Programme to Eliminate Lymphatic Filariasis (FIL), WHO, Geneva, Switzerland (Dr. Kitler); Viral Hepatitis Programme, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, NSW, Australia (Dr. Dore); Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr. Perz, Dr. Armstrong, Dr. Hadler); Royal Free Hospital School of Medicine, London, United Kingdom (Dr. Dusheiko); Clinical Research Center, National Nagasaki Medical Center, Nagasaki, Japan (Dr. Ishibashi); University Hospital, Clinical Immunology Zurich, Switzerland (Dr. Grob); Medical Research Council, University Molecular Hepatology Research Unit, Department of Medicine, Johannesburg, South Africa (Dr. Kew); Service d'Hépatologie, Hôpital Beaujon, Clichy, France (Dr. Marcellin); National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (Dr. Seeff); Department of Epidemiology and Social Medicine, Antwerp, Belgium (Dr. Beutels); Health Technology and Pharmaceuticals (HTP), Vaccines and Biologicals (VAB), Vaccine Assessment and Monitoring (VAM), WHO, Geneva, Switzerland (Dr. Nelson); Evidence and Information for Policy (EIP), Evidence for Health Policy (GPE), Epidemiology and Burden of Diseases (EBD), WHO, Geneva, Switzerland (Dr. Stein); Evidence and Information for Policy (EIP), Health Service Provision (OSD), Human Resources for Health (HRH), WHO, Geneva, Switzerland (Dr. Zurn); International Agency for Research on Cancer (IARC), Unit of Field and Intervention Studies, Lyon, France (Dr. Clifford); Department of Microbiology, Scientific Institute of Public Health, Brussels, Belgium (Dr. Vranckx); Clinica Medica 5, Department of Clinical and Experimental Medicine, Padova, Italy (Dr. Alberti); Communicable Diseases Control, Regional Office for the Eastern Mediterranean (EMRO), Nasr City Cairo, Egypt (Dr. Hallaj); and Communicable Disease Surveillance and Response (CSR/Lyon), WHO, Geneva, Switzerland (Dr. Lavanchy).
Hepatitis C virus (HCV) infection is now a global public health issue. However, the global burden of disease attributable to HCV infection is unknown. The objectives of this WHO informal consultation included the following: (1) defining a strategy to estimate the global burden of disease (GBD) associated with HCV infection in terms of morbidity and mortality, (2) describing the natural history of HCV infection in terms of morbidity and mortality, and (3) identifying areas for which more research is needed. The GBD project is an attempt to examine all causes of morbidity and mortality using an approach common to all conditions. The World Health Organization (WHO) already has estimated the burden of disease associated with hepatitis B virus (HBV) infection and is now about to conduct the same analysis for HCV infection. A review has been conducted to estimate the prevalence of HCV infection by age, gender, and region. These figures can be used to estimate incidence, although there are a number of areas of uncertainty. Combined with natural history parameters, incidence estimates could be used to estimate the future burden due to current infections. However, the present model is not validated and requires calibration before it can be used. A consensus was reached over the strategies to be used to (1) estimate the current burden due to past infections and (2) estimate the future burden due to current infections. Provisional expert consensus was reached over natural history parameters and cofactors that influence them. However, systematic literature reviews and meta-analysis are preferable for obtaining estimates to be included in models. Areas deserving future research include (1) obtaining a better estimate of HCV infection prevalence by age groups, (2) characterizing the various morbidity states associated with HCV infection and their disability weights, (3) understanding the long-term natural history of HCV infection beyond 20 years after infection, and (4) estimating the prevalence (and numbers of) of HCV infection among the drug-using population worldwide. A working group was created to address unmet needs and to assist the WHO in estimating the GBD associated with HCV infection.
Key Words: Hepatitis C virus • global burden of disease • World Health Organization • morbidity • mortality • GBD project
Address for reprints: Dr. Daniel Lavanchy, Communicable Disease Surveillance and Response (CSR), World Health Organization (WHO), 20, Avenue Appia, CH-1211 Geneva 27, Switzerland.
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