Spain, on World Hepatitis Day, is on the right track for the elimination of hepatitis C in its population. Although the World Health Organization (WHO) has set the horizon for 2030 worldwide, over 2023 and 2024.

The viral hepatitis (HAV, HBV, HCV, HDV, and HEV) consist of inflammation of the liver caused by a viral infection. In the case of hepatitis A and E, the main route of transmission is faecal-oral, especially in countries with poor hygiene and contaminated water. “Hepatitis A is transmitted from person to person, mainly due to inadequate hand hygiene or the consumption of contaminated food. In Spain the prevalence is currently low, but in the 1960s, for example, it was a frequent disease because most children passed the infection asymptomatically and with great contagion through the hands, “explains García-Samaniego .

Most cases of hepatitis E in Spain they are derived from zoonosis and are mainly related to the pig herd. The infection is transmitted to humans by eating undercooked, contaminated meat and can lead to acute hepatitis.

HBV It is transmitted by contact with the blood or body fluids of infected people, and its main routes of transmission worldwide are perinatal (from mother to child during childbirth), between children, by injections and transfusions, or by sexual practices without protection. Hepatitis C, on the other hand, is of ‘parenteral transmission’, which means that people become infected by direct contact with infected blood.

Thanks to the effective treatments and if accompanied by an improvement in the active search for patients in vulnerable groups and the general population, their elimination could be achieved between 2023-24

In Spain, of the different types of viral hepatitis that exist, there is a vaccine for hepatitis B, endemic in the Mediterranean basin, which is administered to the entire population in newborns since 1996, and for A, included in Catalonia, Ceuta. and Melilla and recommended in the rest of the Autonomous Communities to risk groups. Regarding the prevalence of HBV infection, the WHO considered Spain as an intermediate prevalence country (2-8%), in line with the rest of the Mediterranean countries. .

In the case of hepatitis C there is still no vaccine “as it is a very elusive virus”, explains Javier García-Samaniego, although “the drugs we have provide us with an extraordinary cure rate of practically 100%, and there is real access to them from the entire Spanish population. In 2015, the date of approval of the PEAHC, a prioritization of treatments was established for patients with moderate-advanced liver fibrosis, but since 2017 access is universal. Anyone diagnosed with hepatitis C is treated with these drugs and cured. “

According to seroprevalence data from a Ministry of Health survey published in 2019, the prevalence of HCV antibodies is 0.85% and the prevalence of active infection is even lower thanks to treatments, at 0.22.

The definitive elimination of the disease, indicates, «rests on two legs: the identification of vulnerable groups and population screening between the ages of 40 and 70 ”, which makes it absolutely essential to“ monitor the most vulnerable groups to achieve the elimination of hepatitis C, much more necessary today if possible for the added difficulties as a consequence of the COVID-19 pandemic on these groups, difficult to integrate into a normal healthcare circuit, and on the other hand, effective population screening because 4 out of 5 cases occur in people over 50 years of age “.

For hepatitis E currently there is no effective treatment or vaccine, “China has developed one but does not have WHO authorization,” says the researcher, “and currently only ribavirin has been shown to reduce viral load in chronic infections in immunosuppressed patients, due to what is the most widely used drug ».

It sets as challenges to increase the protection of people who do not respond to vaccines, to decrease the doses and to provide protection against possible mutant viruses

Regarding the evolution of hepatitis B and A in Spain, Ángela Domínguez, principal investigator of the CIBER group on Epidemiology and Public Health (CIBERESP) at the University of Barcelona and researcher on vaccines, indicates as key the introduction of vaccines to stop its impact. «The introduction of the hepatitis B vaccine in the systematic schedules has managed to significantly reduce the incidence of the disease. Although we only declare cases of acute disease, we can see the reduction of 71.6%, going from a rate of 2.96 per 100,000 inhabitants in 1997 to 0.84 in 2018, ”he says.

In the case of the vaccine antihepatitis A, available since 1995, in our country is recommended for risk groups such as men who have sex with men, drug users, people with chronic liver disease, transplants, health personnel who work in risky environments, travelers to endemic areas and people who follow an international adoption process in these countries. The data shows, indicates Angela Domínguez, “that in Spain we have gone from an incidence of 4.61 per 100,000 inhabitants in 1997 to 3.67 in 2018, which represents a decrease of 20%”.

People who are at risk for infection due to their profession (health workers, firefighters, coroners, cleaning staff, prison workers, people who practice invasive techniques such as acupuncture, piercings, tattoos, sex workers) and people with risky sexual practices should be vaccinated. Parenteral drug users and international travelers

Diseases that can be eliminated through vaccination

There is currently agreement among experts that the elimination of hepatitis B is possible thanks to vaccination, although this objective requires high vaccination coverage for many generations (fortunately the coverage is very high in Spain, at 98.2% in the year 2018). According to the CIBERESP researcher, “our vaccines are highly effective and the strategy is adequate to be able to eliminate the transmission of the B virus in immunocompetent people.”

Although the vaccine is very effective and is administered in the first year of life in all Autonomous Communities, researchers from the CIBERESP group at the University of Barcelona published a study in 2019 to find out, 21 years after its implementation, the effectiveness of the vaccination program in pre-adolescents in Catalonia that had been started in 1991.

The incidence rate of hepatitis B was 4.1 per 100,000 person-years in the unvaccinated cohort and 0.03 in the vaccinated cohort, demonstrating an effectiveness of the vaccination program of 99.30%. “These data demonstrate that the effectiveness of the hepatitis B vaccination program in preadolescents has been very high, with the consequent benefit for the community,” he says.

The effectiveness of the vaccination program against hepatitis B in preadolescents has been very high, with the consequent benefit for the community

Both researcher Javier García-Samaniego and Ángela Domínguez agree that the hepatitis B vaccine must continue to be administered systematically to all children in the first year of life and to all the risk groups that are not immunized they have the age that they have.

These groups should include people with kidney failure or hemodialysis, with chronic liver disease, in solid organ transplant programs, patients with HIV, with sexually transmitted diseases, with inflammatory bowel disease, habitual recipients of blood products and receiving immunosuppressive treatments).

Likewise, people who are at risk of becoming infected by their profession (health workers, firefighters, medical examiners, cleaning personnel, prison workers, people who practice invasive techniques such as acupuncture, piercings, tattoos, sex workers) and people with sexual practices should be vaccinated. risk, injecting drug users and international travelers.

People who travel abroad, especially to countries at risk, “should always be vaccinated against hepatitis A and B, and this will be indicated at the International Vaccination Centers,” says Javier García-Samaniego. Hepatitis A is distributed worldwide, but it is more common where sanitary conditions are poor and the safety of drinking water is not well controlled.