The burden of chronic hepatitis B and C in 2022 and progress towards elimination: a global report

Background
WHO has worked closely with member states to set baseline targets, monitor progress and gaps, and develop a strategy to achieve the elimination of viral hepatitis as a public health threat by 2030. This analysis aimed to use the latest data to assess global progress, identify gaps, and provide strategic support to countries and regions to scale up prevention and treatment services to meet global, regional, and country-level targets.

Methods
Data on key indicators for 2022 were collated in 2023, including prevalence, incidence, mortality, and the cascade of care for chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. WHO country offices, regional offices, related departments, and partners were involved to verify and ensure the quality and completeness of the data. Data from 2022 were compared with historical data to monitor progress, and reported data were compared with expected data and targets to identify gaps in incidence and mortality.

Findings
As of June 30, 2023, WHO had received verified data reports from 187 of 194 countries and territories, including data contributions from collaborative partners. We estimated that, in 2022, globally, 254 million (3·27%) of 7758 million people were living with chronic HBV infection and 50 million (0·65%) people were living with HCV infection. Overall, five countries (China [83·7 million; 27·5%], India [35·3 million; 11·6%], Indonesia [18·9 million; 6·2%], Nigeria [15·7 million; 5·2%], and Pakistan [12·6 million; 4·2%]) accounted for 55% of the combined global burden of HBV and HCV. There were more than 2·2 million (95% CI 1·8–2·7) new chronic HBV and HCV infections and more than 1·3 million (95% CI 1·1–1·6) deaths due to HBV and HCV in 2022, with the majority of deaths due to HBV (1·1 million [95% CI 0·98–1·24]); as a result, the point estimate for deaths due to hepatitis in 2022 exceeded that of deaths due to tuberculosis in 2023 (1·25 million [95% UI 1·13–1·37]). There were 1·2 million new chronic HBV infections worldwide in 2022; 62·7% (771 000) of these new infections occurred in the African Region. In 2022, 34·1 million (95% CI 30·2–38·5) individuals living with HBV were diagnosed; of these, 6·6 million (95% CI 5·9–7·5) received antiviral treatment. In 2022, 25·7 million (95% CI 19·5–28·8) individuals were diagnosed with HCV infection and 12·5 million (95% CI 9·5–14·0) were treated with direct-acting antiviral drugs in 2015–22.

Interpretation
Viral hepatitis represents a substantial burden of infectious disease globally, comparable with that caused by tuberculosis. Progress towards global hepatitis elimination is currently insufficient to meet the 2030 targets defined in the UN Sustainable Development Goals; efforts need to be rapidly and urgently scaled up across all regions. In particular, given the rising mortality due to hepatitis B globally, expansion of hepatitis B vaccination is a priority, particularly in the African Region, where the majority of new chronic HBV infections occur. Access to prevention, diagnosis, and treatment services needs to be scaled up substantially by the end of 2026 to meet the 2030 global hepatitis elimination targets.

Funding
World Health Organization.