Notice

[2021 World Hepatitis Day] Korea’s Response and Management Strategies to Eliminate Viral Hepatitis

2021-07-28

Korea’s Response and Management Strategies to
Eliminate Viral Hepatitis

On World Hepatitis Day, July 28, Institut Pasteur Korea CEO Dr. Youngmee Jee presented strategies for strengthening Korea's hepatitis response and management capabilities. Dr. Jee, who majored in virology, is a global hepatitis expert and has been working as a World Health Organization (WHO) Hepatitis B Expert Resource Panel for the Western Pacific since 2015.

“In 2016, WHO presented the ‘Global Health Sector Strategy on viral hepatitis*’ and set global goals to reduce** the incidence of hepatitis by 90% and the death rate by 65% by the year 2030,” Dr. Jee explained. “With an achievement of a significant reduction in hepatitis B prevalence through the Hepatitis Vaccination Project, Korea should now set the goal of hepatitis eradication beyond prevention, in line with global efforts, and promote national strategy and cross-ministerial cooperation,” said Dr. Jee.

* Global Health Sector Strategy (GHSS) on viral hepatitis, ** Compared to 2015, the incidence of HBV decreased by 95%, and the incidence of HCV decreased by 80%

Dr. Jee suggested key strategies outlined as establishment of a national hepatitis elimination framework, formation of a dedicated department for implementation, strengthening communication with domestic experts, and participation in global programs.

In particular, she argued that it is necessary to establish a viral hepatitis elimination roadmap that defines detailed action plans for each year and merge the domestic management systems and expertise separated according to hepatitis type (B, C, and A&E) to strengthen the driving force. She explained that many countries, including the United States, which has a lower hepatitis prevalence compared to Korea, have formed an organization dedicated to hepatitis and are effectively conducting management and research at the national level. Taking the U.S. Centers for Disease Control and Prevention (CDC) as an example, she added that the Division of Viral Hepatitis conducts epidemiology, surveillance, prevention and research on all types of hepatitis (A to E), and pushes for the global goal of viral hepatitis elimination with 2021-2025 Viral Hepatitis Plan*.
* Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination 2021-2025 (Viral Hepatitis Plan)

“Korea also established an overall plan for viral hepatitis management through the ‘2nd Basic Plan for Infectious Disease Prevention and Management for 2018-2022’, but is not seeing clear results due to the absence of a systematic implementation plan and dedicated department,” Dr. Jee said. “It is regrettable that a dedicated department was not formed when the Korea Disease Control and Prevention Agency (KDCA) was promoted last year, and it remains as an agenda be addressed in the future through along with the establishment of a framework to combat hepatitis,” she spoke.

In addition, emphasizing the importance of strengthening communication among domestic experts and participating in global programs, Dr. Jee mentioned, “We will be able to enhance our expertise on hepatitis management policy through extensive communication and cooperation among various partners including the KDCA, Korean Association for the Study of the Liver (KASL), the Health Insurance Review & Assessment Service, and the Korea Association of Health Promotion.” “I hope that Korea will be able to heighten its healthcare status by participating in global efforts to eliminate viral hepatitis, including WHO's ‘Global Health Sector Strategy on viral hepatitis’,” she said.

Furthermore, Dr. Jee added, “I hope that there will be continuous investment in projects with excellent results such as the cohort project of hepatitis B and C patients which monitors hepatitis patients on a large scale, as well as active establishment of site-based policies based on projects like the ‘Hepatitis C Early Detection Pilot Project’.”

World Hepatitis Day (July 28)
: Established by the World Health Organization (WHO) in 2010. July 28 is the birthday of Dr. Baruch Bloomberg (United States), who won the Nobel Prize in Medicine (1976) for his discovery of the hepatitis B virus.

[Attachment: Viral hepatitis in Korea*]

The liver is the largest organ in our body, weighing about 1.5Kg in adults, and performs major roles including energy management, detoxification, and hormone decomposition and metabolism. Hepatocytes are slowly destroyed, and due to this characteristic, they do not generate symptoms until the damage progresses and the function deteriorates significantly; thus it is called the “silent organ”.

Hepatitis is a disease in which the liver is inflamed due to infection with hepatitis A, B, C, D, or E viruses.

According to the KASL, HBV, which is transmitted through blood or bodily fluids, is the most prevalent hepatitis in Korea. About 4% of the Korean population is infected with HBV, and it is estimated that about 400,000 of them are chronic hepatitis B patients who remain infected for more than 6 months. In particular, chronic hepatitis B is highly likely to progress into serious liver disease such as cirrhosis or liver cancer, and about 50 to 70% of the 20,000 deaths due to liver disease are a result of chronic hepatitis B.

HCV is also transmitted through blood or bodily fluids. KASL estimates that about 1% of Korean population carry HCV, and among them, 70-80%, which is a higher rate than hepatitis B, become chronic hepatitis C patients. 30-40% of chronic hepatitis C cases progress into cirrhosis or liver cancer. Particularly, in 2015, there was a case of group infection in Korea that occurred due to reusing of syringes at a specific hospital. Unlike hepatitis B, there is no vaccine for hepatitis C due to its high mutation rate; however, a direct-acting antiviral (DAA) which directly inhibits the replication of HCV has recently been developed. These drugs are being covered by national health insurance of Korea since 2015. Thus, hepatitis C can be cured if detected early and properly treated.

In Korea, hepatitis B and hepatitis C are classified as Class 3 infectious diseases that require full surveillance, for which various government-centered response efforts are being implemented.

In the case of hepatitis B, the number of domestic patients was greatly reduced through vaccination. In particular, to prevent vertical transmission from mother to child, which is the main cause of hepatitis B in Korea, the “Hepatitis B Vertical Transmission Prevention Project” has been executed since 2002 to vaccinate and test newborns free of charge.

Moreover, the “Hepatitis C Early Detection Pilot Project” was implemented in 2020 to review the need to introduce a hepatitis C screening test as a national health examination item since early diagnosis and treatment hepatitis C is critical. Through this project, a total of over 100,000 people aged 56 years of age were tested for hepatitis C free of charge during general health checkup. Compared to non-implementation, incidence of cirrhosis and liver cancer as well as mortality was significantly reduced and cost-effectiveness was confirmed.

* References
1. KASL. Liver disease at a glance 2018
2. KASL. Hepatitis: knowing more helps 2019

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