On the Occasion of the World Hepatitis Day: World Hepatitis Day and Our Achievements and Responsibilities in Iran

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major causes of liver disease worldwide and the health policy makers with their strategies try to control these infections in the communities.[1–5] HBV infection is the main cause of chronic liver disease in Iran,[6] but fortunately prevalence has decreased dramatically in the Iranian population during last decade[6] and the endemicity of infection is changing from intermediate to low in Iran.[7] Improvement of the people's knowledge about HBV risk factors, national vaccination program since 1993 for all neonates, vaccination of adolescence, and vaccination of high risk groups could be the cause of this decrease.[8,9] Ministry of Health in Iran is serious about controlling hepatitis B. Coverage rate more than 97% of infants, expansion of vaccination to more age in adolescent period, vaccination of health-care workers, and family of HBs Ag positive free of charge are the main strategies in Iran.[10] But we need to more evaluation of risk factors in HBV-infected people for designing the strategies to control the disease in future. Higher prevalence of HBV infection in some parts of Iran such as Golestan province needs more attention.[11]

HCV is an emerging disease worldwide and will be a potential source of substantial cases of morbidity and mortality in the future.[12] It is estimated that approximately 170 million individuals, i.e., 3% of the world's population, are chronically infected with the HCV.[13] The prevalence varies markedly from one geographical area to another and within the population assessed.[7] Iran is a low prevalence of HCV infection and the estimation in the general population shows that it is less than 0.5%.[4,14] The epidemiological patterns of HCV vary greatly among the different countries and even among the regions of the same country. The epidemiology varies geographically and temporally due to its distribution and the evolution of risk factors.[15] Studying the epidemiology and risk factors of HCV infection plays an important role in the methods of its prevention. Injection drug users (IDUs) are the main risk factors for acquiring of HCV infection in our community.[16] In addition to drug use, most drug abusers experience high-risk behaviors such as unsafe sexual activities, tattooing, unsafe injections, and cocaine use resulting in high prevalence rates in the IDUs group in our country.[17] A range of prevention measures for IDUs has been implemented including syringe exchange programs, syringe vending machines, increased outreach efforts, and access to methadone maintenance treatment (MMT).[18] In Iran, the harm reduction program has been accepted by the high level authorities in the government and we adapted it to our religious and traditional culture and it is very effective plan in control of HCV infection in this high-risk group.[18,19] It seems that HCV infection is more concentrate in hemodialysis, hemophilia, and thalassemia patients in Iran and fortunately during recent years the burden of infection has decreased significantly in these groups.[2,3,20] Screening of all thalassemia and hemophilia patients for HCV infection in all provinces in Iran and providing the free of charge of antiviral drugs was the best strategy for control of HCV infection in this high-risk group.[21–23] With implementation of mandatory HCV screening of blood and blood products in the 1995 in Iran, the number of posttransfusion infections had already decreased dramatically in special patients.[24] The epidemiological patterns of HCV vary greatly among the different countries and even among the regions of the same country.[25,26]

World Hepatitis Day (28 July) is an annual event that has marked to increase the awareness and understanding of viral hepatitis and the diseases that it causes. July 28th is the birthday of Dr. Baruch Blumberg. Dr. Blumberg discovered the hepatitis B virus in 1967 and 2 years later developed the first hepatitis B vaccine and for these achievements won the Nobel Prize. The first Word Hepatitis Day launched by World Hepatitis Alliance in 2008. Following the World Health Assembly in May 2010, it was agreed that World Hepatitis Day would be recognized annually on 28 July. It is an opportunity around the world for raising the people and health policy makers for more knowledge sharing and better approach for control of HBV and HCV infections in their communities. The role of media with collaborations of gastroenterology and hepatology and infectious centers for generation massive public informative and educational materials is very critical. This annual event should provide more sense for collaboration in the communities. The governments will focus on strengthening prevention, screening and control of viral hepatitis with increasing hepatitis B vaccine coverage and integration of viral hepatitis in surveillance system, and coordinating a national response to viral hepatitis in the country. Increasing the access to new tests and therapy for all infected people in the country is another important strategy for control of viral hepatitis in the country.