生活与肝炎：不要害怕

StephenW

Living with hepatitis: Don’t be afraid  Web story
27 July 2015

                                                    Dr Zhang*, a village doctor in Henan province in central China, knows first-hand how destructive hepatitis can be. His father died of liver cancer, most likely caused by undiagnosed hepatitis.  Dr Zhang himself was born before hepatitis B vaccination was widely available and was not immunized against hepatitis B – either at birth or as a child. He went on to develop a serious hepatitis B-related illness as an adult.
                                                    Babies infected at birth, as Dr Zhang may have been, have a much greater risk of a lifetime of chronic liver infections. The World Health Organization now recommends all children be vaccinated within 24 hours of birth, followed by 1-2 more doses within the first 12 months of life.
                                                    Dr Zhang’s hepatitis went undiagnosed until well into his adult life when he became seriously sick with liver disease. Fortunately, he was able to travel to Beijing to access good medical care, including a course of the antiviral drug, entecavir. Following treatment, Dr Zhang’s liver function returned to normal and the village doctor is now in good health.
                                                    Viral hepatitis is an insidious disease – and a major public health threat globally. It is the leading cause of cirrhosis of the liver and liver cancer. In China, there are around 90 million people living with chronic hepatitis B, and almost 10 million people living with hepatitis C – making China alone home to 25% of the world’s chronic viral hepatitis cases.
                                                    In his work as a village doctor, Dr Zhang now uses his own lived experience to educate people about hepatitis.
                                                    “I tell pregnant women that they should get their babies vaccinated. I tell adults who aren’t vaccinated to get tested. And I tell people who I know have hepatitis B: don’t be afraid. Hepatitis B can be treated,” Dr Zhang says.  
                                                    Dr Zhang wants others to know that they can live with chronic hepatitis B infection and still live a healthy and productive life.
                                                    Over the last 25 years, China has achieved remarkable success with its hepatitis B vaccination programme. New data show that less than 1% of under 15 year olds in China are infected with hepatitis B, a reduction of more than 90% compared to the pre-vaccination era.
                                                    “This makes the current generation of Chinese children the first to be almost completely hepatitis B-free, drastically reducing their chances of developing conditions like cirrhosis of the liver and liver cancer later in life. This is a remarkable public health accomplishment,” says Dr Bernhard Schwartländer, WHO Representative in China.
                                                    But more now needs to be done to improve treatment for hepatitis in China, so that more people like Dr Zhang can benefit from access to life-saving drugs. Of the approximately 100 million adults living with hepatitis B or C in China, tens of millions urgently need treatment, but cannot access it.
                                                    Without treatment, up to 3 in 10 chronically infected people will go on to develop life-threatening illnesses like cirrhosis and liver cancer. Liver cancer is the second most common cancer diagnosed in Chinese males, and one of the top five most common cancers in females.
                                                    While hepatitis B is treatable – as Dr Zhang’s case shows – access to treatment in China is difficult. The right drugs are available, but are very expensive because there is no public health programme that provides subsidized access – and not all health insurance schemes reimburse the cost. There are an estimated 28 million people in need of treatment for hepatitis B in China – 7 million of whom are considered high priority because they already have advanced liver disease.
                                                    Hepatitis C can be completely cured with the new, highly effective direct acting antivirals (DAAs), but these drugs are not currently available in China due to lengthy registration and approval processes. The standard treatments that are currently available in China are much less effective, more costly, require multiple injections, and result in more side effects. There are currently an estimated 2.5 million people in the country who urgently need treatment for hepatitis C because they already have advanced liver disease, and therefore a high risk of liver cancer.
                                                    WHO is working closely with the Chinese government to improve access to treatment for people living with both hepatitis B and C.
                                                    “Investing in a public health approach to hepatitis treatment – that is, making treatment available to all who need it through a public subsidy scheme, on an equitable basis – will result in many cancer cases averted, deaths avoided, and significant costs saved for both society and the Government,” said Dr Schwartländer.
                                                    “There is also an urgent need to make drugs which cure hepatitis C available and affordable in China. Drug registration and approval processes must be accelerated so people in China are not missing out on the best treatments for hepatitis that are now available in other parts of the world,” Dr Schwartländer added.
                                                    The issues facing people living with hepatitis in China are mirrored in countries across WHO’s Western Pacific Region. While successful infant hepatitis B vaccination campaigns have led to substantially lower rates of early childhood hepatitis B transmission in many countries, millions of people continue to live with chronic hepatitis B and C without access to effective medicines to prevent the severe complications of chronic infection. Indeed, in the Western Pacific Region there are more deaths from viral hepatitis than from HIV, TB and malaria combined. Yet investment in services and access to treatment remains desperately inadequate, condemning millions to the risk of liver cancer or cirrhosis.
                                                    WHO is driving change to bring to light the human tragedy of these once ‘silent epidemics’ – through coordinated efforts to improve understanding of disease patterns, prevent transmission, and to tackle the many barriers to effective treatment, including the high price of medicines. The Western Pacific Regional Action Plan for Viral Hepatitis lays out a systematic approach to combat hepatitis infection, and prevent avoidable deaths. It also provides a template for countries to tailor their public health response to the needs of local communities.
                                                    Through strengthening national and regional action on hepatitis, hepatitis infections can be prevented, and like Dr Zhang, more pe ople will be able to access effective medicines for treatment of hepatitis.

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                                                    *Not his real name.

StephenW

生活与肝炎：不要害怕

网络的故事
2015年7月27日

张医生*，一个乡村医生河南省中国中部，知道第一手如何破坏肝炎都可以。他的父亲死于肝癌，最有可能被确诊肝炎引起的。张医生本人出生前接种乙肝疫苗是广泛使用，对乙肝没有免疫 - 无论是在出生时或作为一个孩子。他又患上严重的乙肝相关的疾病，作为一个成年人。

在受感染的婴儿出生，因为张医生可能已经，有慢性肝病感染一生的风险更大。世界卫生组织建议，现在孩子们都可以在出生24小时，其次是1-2以上剂量人生的第一个12个月内接种。

张医生的肝炎顺利，直到确诊到他成年时，他成为重病肝脏疾病。幸运的是，他能够前往北京访问良好的医疗服务，包括抗病毒药物的过程中，恩替卡韦。治疗后，张医生的肝功能恢复正常，村医是目前健康状况良好。

病毒性肝炎是一个阴险的疾病 - 和全球重大的公共卫生威胁。它是在肝脏和肝癌的肝硬化的主要原因。在中国，每年大约有9000万人患有慢性乙肝，而近10万人感染了丙型肝炎 - 让中国独自在家的世界慢性病毒性肝炎病例的25％。

在他作为一个乡村医生的工作，张医生现在使用自己的生活经验来教育人们了解肝炎。

“我告诉孕妇，他们应该得到他们的孩子接种疫苗。我告诉谁不接种疫苗得到测试成年人。我告诉谁，我知道有乙肝的人：不要害怕。乙肝是可以治疗的，“张医生说。

张医生希望别人知道他们生活的慢性乙肝感染和仍然生活健康和富有成效的生活。

在过去的25年里，中国已凭借其乙肝疫苗接种计划取得了显着成效。新的数据显示，在15岁的年轻人在中国不足1％是感染了乙肝，相较于接种前时代的减少90％以上。

“这使得当前一代中国孩子的第一个几乎完全乙肝自由，极大地减少在以后的生活发展，如肝和肝癌肝硬化条件的机会。这是一个了不起的公共卫生成就，“博士施贺德，世界卫生组织驻中国代表说。

但现在更需要做改善治疗肝炎在中国，让更多的人喜欢张可医生从获得救命药物中受益。的约100万成年人患有在中国乙型或丙型肝炎，数以千万计的迫切需要治疗，但不能访问它。

如果不进行治疗，长达3 10慢性感染的人会继续发展危及生命的疾病，如肝硬化和肝癌。肝癌是第二个最常见的癌症诊断中国男性和五大最常见的癌症在女性之一。

虽然乙肝是可以治疗 - 张医生的案例显示 - 获得治疗在中国是很难的。正确的药物可用，但非常昂贵，因为没有公共健康计划，提供资助的访问 - 而不是所有的医疗保险制度报销的费用。估计有2800万人需要治疗乙肝在中国 - 7000000人被认为是高优先级，因为他们已经拥有先进的肝脏疾病。

丙型肝炎可以用新的，高效的直接作用抗病毒药物（的DAA）完全治愈，但这些药物目前未在中国上市，由于冗长的注册和审批程序。当前可用在中国的标准治疗是小得多有效，更昂贵，需要多次注射，并导致多种副作用。目前在全国大约有250万人谁急需治疗C型肝炎，因为他们已经拥有先进的肝脏疾病，因此肝癌的高危人群。

世卫组织正在与中国政府改善获得治疗患有乙型肝炎和C.人

“投资于公共卫生的方法来治疗肝炎 - 那就是，使治疗提供给所有谁需要它通过公开补贴方案，在平等基础上 - 将导致许多避免癌症病例，死亡病例可以避免，并保存显著的成本为社会和政府，“博士施贺德说。

“还有一个迫切需要使药物，治愈丙型肝炎获得和负担得起的中国。药品注册和审批程序必须加速让中国人都不会错过肝炎是目前在世界其他地区提供最好的治疗，“博士施贺德增加。

生活与肝炎中国人民所面临的问题反映在整个世卫组织西太平洋区域的国家。虽然成功的婴儿乙肝疫苗接种运动已导致幼儿乙肝传播到相当低的利率，在许多国家，数以百万计的人继续与慢性乙型和丙型肝炎生活在没有获得有效的药物，以防止慢性感染的严重并发症。事实上，在西太平洋地区有病毒性肝炎比艾滋病，结核病和疟疾的总和还要多死亡。然而，投资服务和获得治疗仍然拼命不足，谴责百万肝癌或肝硬化的危险。

世卫组织正在推动变革带来的光这些曾经“沉默的流行病”的人间悲剧 - 通过协调努力提高疾病模式的理解，防止传播，并解决了许多障碍，有效的治疗方法，包括价格高的药品。病毒性肝炎西太平洋区域行动计划提出了以打击肝炎病毒感染，并防止可避免的死亡系统化的方法。它还提供了一个模板，为各国调整其公共卫生应对当地社区的需要。

通过加强对肝炎的国家和区域行动，肝炎感染是可以预防的，而像张医生，更多的PE德隆将能够访问有效的药物治疗肝炎。

*不是他的真名。