Viral Hepatitis Prevention Board Meeting on Hepatitis A and E: Update on Prevention and Epidemiology

This issue of Viral Hepatitis reviews topics covered at the Viral Hepatitis Prevention Board (VHPB)’s spring meeting on Hepatitis A and E: Update on Prevention and Epidemiology, held on March 12-13, 2009 in Antwerp, Belgium. Main topics related to Hepatitis A (HAV) included feedback of the Global HAV meeting held in December 2007 in Miami, and related lessons learned for the WHO European region. Recent information on HAV epidemiology, outbreaks and prevention was also provided and future initiatives were discussed among participants. With regards to Hepatitis E (HEV), an overview of HEV virology and the disease was given together with its worldwide epidemiology, including data suggesting zoonotic transmission. The emergence of HEV in non-endemic/endemic countries was assessed and future opportunities of an HEV vaccine were discussed. The state of the art on HAV emphasized the growing public health importance of the disease with related need for control at global level. Many developing countries are moving from high to intermediate endemicity, with growing cohorts of susceptible young people leading to increased risk of outbreaks. Also, the clinical picture of HAV disease appears to be changing, with seemingly more fulminant HAV cases, especially in Latin America. Other meeting highlights revealed that HAV burden of disease data is still not well documented and that there is no standardized global approach in terms of HAV control and prevention in spite of the availability of safe and effective HAV vaccines since 16 years. The need for improved surveillance and burden of disease data, together with robust mathematical modeling and economic analyses, particularly in the context of the current financial crisis, was emphasized. From meeting discussions it appeared that more effective advocacy is needed to place the importance of HAV on the international public health agenda and prioritize HAV on work plans of national and international organizations. Advocacy is also required to maintain the momentum from important international HAV meetings that took place in Miami and Riga, as well as the planned revision of the WHO position paper on HAV. Meeting discussions concluded that there is a need for “leadership” on HAV to stimulate the production of guidelines, agreement of definitions, strengthening of surveillance, and greater advocacy for HAV prevention and control, and a call for action. Information shared on HEV showed that, after the declining circulation of HAV, it has now become the most frequently isolated hepatitis virus transmitted through water and food. However, HEV transmission routes are still unclear, (e.g. whether pig reservoirs are responsible for zoonotic transmission), and more research is needed to understand the different clinical presentations of the disease. Also, a clear need was expressed for reliable and standardized diagnostic assays in order to collect accurate burden of disease data. The opportunity of an HEV vaccine was also discussed among participants. Two candidate vaccines are currently being developed but questions remain in terms of the demand and financing of further development required for commercialization, as well as the urgent need to resolve existing intellectual property issues. In order to advocate and mobilize support for the further development of HEV vaccines there is also a high need for more robust data on the disease burden and impact on society. To this end, partnerships should be established, in particular the potential role of private-public sector partnerships should be investigated.