Cover image for article: Viral Hepatitis and the Campaign to Find the Missing Millions

This World Hepatitis Day (28 July) the World Hepatitis Alliance launched Find the Missing Millions – a three-year campaign to raise awareness of viral hepatitis and improve advocacy.

Globally, 325 million people are living with viral hepatitis but it is estimated that 300 million are unaware they have the disease.

The World Hepatitis Alliance wants the campaign to ‘influence national testing policies and encourage people to get screened and/or become advocates in the quest to find the undiagnosed.’

Nurses are well positioned to support the campaign objectives to:

  1. Raise awareness of the importance of increasing diagnosis and linkage to care;
  2. Encourage people to get tested;
  3. Underscore the need for national testing policies;
  4. Educate and inform wider audiences about viral hepatitis, with a specific focus on prevention, treatment and testing.

(World Hepatitis Alliance 2018)

What is Viral Hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. There are five types of hepatitis viruses: hepatitis A, B, C, D and E.

Viral hepatitis is one of the biggest global health threats of our time, according to the World Health Organisation. 1.34 million deaths a year and 2 out of 3 liver cancer deaths are caused by this silent epidemic. Children and marginalised communities are most likely to be at risk.

But, despite the scale of the challenge, the World Hepatitis Alliance explains that there are now strong foundations to eliminate viral hepatitis as:

  • A global elimination strategy (2016) is in place with every country in the world committed to eliminating the virus by 2030;
  • There is treatment and vaccine for Hepatitis B and a cure for Hepatitis C and;
  • The Sustainable Development Goals* include viral hepatitis.

* – a set of 17 Global Goals set in 2015 by the United Nations

Australia is one of the countries which has already reached WHO’s interim diagnosis target, for Hepatitis B and Hepatitis C, of 30% by 2020. The UK has not yet reached this target.

Raising awareness and understanding of the disease and improving access to diagnosis, treatment and care is key to increasing diagnostic rates and building on these foundations.

The World Hepatitis Alliance is keen to encourage nurses, along with other healthcare workers, to play their part by:

  • Knowing the risks;
  • Preventing infections – ensure your hands, instruments and environment are clean;
  • Getting tested and testing your patients, if applicable;
  • Joining the quest to ‘find the missing millions.’

What Can Nurses Do?

Nurses have a very important role in addressing this global health threat by helping find and advocate for the missing millions.

In the UK, the National Institute for Health and Care Excellence (NICE), ‘NICE Testing Guideline for Hepatitis B and C’ recommends nurses should engage in the following activities:

  • Awareness-raising about hepatitis B and C among the general population, including information on
    • main routes of infection and transmission,
    • the hepatitis B vaccination,
    • benefits of early testing and treatment,
    • and the potential for chronic infection to be asymptomatic.
  • Awareness-raising for people at increased risk of hepatitis B or C infection.
  • Developing the knowledge and skills of healthcare professionals and others providing services for people at increased risk of hepatitis B or C infection.
  • Testing for hepatitis B and C in primary care, including
    • practice nurses asking newly registered adults if they have ever injected drugs, including image and performance enhancement substances, at their first consultation,
    • practice nurses offering hepatitis B testing and vaccination to men who have sex with men who are offered a test for HIV and have not previously tested positive for hepatitis B antibodies,
    • practice nurses offering hepatitis B vaccination to people who test negative for hepatitis B but remain at increased risk of infection.
  • Practice nurses offering annual testing for hepatitis C to people who test negative for hepatitis C but remain at increased risk of infection.
  • Practice nurses ensuring people diagnosed with hepatitis B or C are referred to specialist care.
  • ‘Staff providing antenatal services, including … practice nurses …, should ask about risk factors for hepatitis C during pregnancy and offer testing for hepatitis C to women at increased risk. Women who are diagnosed with hepatitis C should be offered hepatitis A and B vaccination in line with immunisation guidance’ (NICE 2016).

You can find out more about the Finding the Missing Millions Campaign along with further resources, and campaign materials at the World Hepatitis Alliance’s website.

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Catherine Smith

Catherine Smith is a UK-based health consultant, researcher and writer. She is also a specialist researcher and writer for the Health and Education Consultancy Pool, Commonwealth Secretariat. Catherine has expertise in health literacy and information, support and advocacy and wide-ranging experience in developing health projects that are sustainable and make a practical difference. She has written UK evidence-based guidance for the Big Lottery Fund on what makes Health and Wellbeing projects work being/publications . A particular focus of her work is health access and addressing the needs of people living with long term conditions who may be older, frail or vulnerable.