Kathryn H. Jacobsen

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013

BACKGROUND With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. METHODS We estimated mortality using natural history models for acute hepatitis infections and GBDs cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). FINDINGS Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. INTERPRETATION Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. FUNDING Bill & Melinda Gates Foundation.

Declining hepatitis A seroprevalence: a global review and analysis.

Hepatitis A virus (HAV) is spread by faecal-oral contact or ingestion of contaminated food or water. Lifelong immunity is conferred by infection or vaccination, so anti-HAV seroprevalence studies can be used to indicate which populations are susceptible to infection. Seroprevalence rates are highly correlated with socioeconomic status and access to clean water and sanitation. Increasing household income, education, water quality and quantity, sanitation, and hygiene leads to decreases in HAV prevalence. Japan, Australia, New Zealand, Canada, the United States, and most European nations have low anti-HAV rates. Although anti-HAV rates remain high in most Latin American, Asian, and Middle Eastern nations, average seroprevalence rates are declining. Surveys from Africa generally indicate no significant decline in anti-HAV rates. Because the severity of illness increases with age, populations with a high proportion of susceptible adults should consider targeted vaccination programmes.

Hepatitis A virus seroprevalence by age and world region, 1990 and 2005

OBJECTIVE To estimate current age-specific rates of immunity to hepatitis A virus (HAV) in world regions by conducting a systematic review and meta-analysis of published data. The estimation of the global burden of hepatitis A and policies for public health control are dependent on an understanding of the changing epidemiology of this viral infection. METHODS Age-specific IgG anti-HAV seroprevalence data from more than 500 published articles were pooled and used to fit estimated age-seroprevalence curves in 1990 and 2005 for each of 21 world regions (as defined by the Global Burden of Disease 2010 Study). FINDINGS High-income regions (Western Europe, Australia, New Zealand, Canada, the United States, Japan, the Republic of Korea, and Singapore) have very low HAV endemicity levels and a high proportion of susceptible adults, low-income regions (sub-Saharan Africa and parts of South Asia) have high endemicity levels and almost no susceptible adolescents and adults, and most middle-income regions have a mix of intermediate and low endemicity levels. CONCLUSION Anti-HAV prevalence estimates in this analysis suggest that middle-income regions in Asia, Latin America, Eastern Europe, and the Middle East currently have an intermediate or low level of endemicity. The countries in these regions may have an increasing burden of disease from hepatitis A, and may benefit from new or expanded vaccination programs.

Bullying among middle-school students in low and middle income countries

This analysis of data from the Global School-based Student Health Survey examined the prevalence of bully victimization in middle-school students in 19 low- and middle-income countries and also explored the relationship between bullying, mental health and health behaviors. In most countries, boys were more likely than girls to report being bullied and the prevalence of bullying was lower with increasing age. Students who reported being bullied in the past month were more likely than non-bullied students to report feelings of sadness and hopelessness, loneliness, insomnia and suicidal ideation. Bullied students also reported higher rates of tobacco use, alcohol use, drug use and sexual intercourse.

Bullying and Symptoms of Depression in Chilean Middle School Students

BACKGROUND The goal of this study was to assess the association between bullying and symptoms of depression among middle school students in Chile. METHODS Secondary data analysis of Chiles 2004 Global School-Based Health Survey. RESULTS A total of 8131 middle school students participated in the study. Forty-seven percent of students reported having been bullied in the past month and 30% reported having been sad and hopeless for 2 or more weeks in the past year. Students in the seventh and eighth grades were more likely to report having been bullied in the past month than students in ninth grade. Ninth grade students reported higher levels of loneliness, difficulty sleeping, and suicidal thoughts than students in the seventh and eighth grades. Boys were more likely than girls to report being bullied in the past month, but girls were more likely than boys to report symptoms of depression, such as prolonged feelings of sadness and hopelessness, loneliness, difficulty sleeping, and suicidal thoughts. Students who reported being bullied in the past month were more likely than nonbullied students to report symptoms of depression. A higher number of days of being bullied in the past month was associated with a statistically significant increase in reported rates of sadness and hopelessness (p < .001). CONCLUSIONS Bullying is common among middle school children in Chile, and bullying and symptoms of depression are strongly linked. This finding is consistent with studies of bullying and depression in adolescents from other parts of the world.

Ebola in Freetown Area, Sierra Leone — A Case Study of 581 Patients

Ebola virus continues to cause considerable disease in West Africa, with an initial 70% associated mortality. This report shows improving survival at one center in Sierra Leone.

A systematic review of the association between breastfeeding and breast cancer.

Breastfeeding is hypothesized to reduce the risk of breast cancer primarily through two mechanisms, differentiation of breast tissue and reduction of the lifetime number of ovulatory cycles, but previous reviews of the association between breastfeeding and breast cancer have not consistently found that breastfeeding reduces risk of breast cancer. Our systematic review yielded 30 case-control studies and 1 cohort study published between 1999 and 2007. Of the 27 studies that assessed the effect of ever breastfeeding compared with never breastfeeding, only 11 found significant protection against breast cancer. Of the 24 studies of the effect of breastfeeding duration, only 13 found a reduced risk of breast cancer with extended lactation. We conclude that no consensus about the relationship between breastfeeding and breast cancer is emerging. Expanded consideration of possible confounders for this relationship is required to determine if breastfeeding is protective and how protection might be conferred.

Priorities for women's health from the Global Burden of Disease study

Womens health is increasingly recognized as a global health priority. It is essential to address not only sexual and reproductive health, but also other health issues that occur throughout life. This paper uses the 2005 estimates of morbidity and mortality from the WHO Global Burden of Disease study and a review of the literature to identify key areas of concern for women by age group and world region. The leading causes of death in women aged between 15 and 44 years include infectious diseases such as HIV/AIDS, tuberculosis, maternal health conditions, and injuries. The leading causes of death in women aged 45 years and older include cardiovascular diseases, chronic obstructive pulmonary disease, and other noncommunicable conditions. Neuropsychiatric and sensory disorders are a major cause of disability for both age groups. An understanding of the key regional and age‐specific priorities for womens health will facilitate the development of appropriate interventions and policies to reduce disease burden.

Risk factors for Mycobacterium ulcerans infection

Mycobacterium ulcerans infection (Buruli ulcer) causes necrotizing lesions that may lead to scarring, contractures, osteomyelitis, and even amputation. Despite decades of research, the reservoirs and modes of transmission for M. ulcerans remain obscure. A thorough evaluation of the potential risk factors examined in comparative epidemiological studies may help to identify likely transmission routes. A systematic search of the literature found that poor wound care, failure to wear protective clothing, and living or working near water bodies were commonly identified risk factors. Socioeconomic status, BCG vaccination, and direct water contact were not associated with significantly increased or decreased risk of infection. Additional comparative studies are required to clarify the potential roles of water contact and insect bites in transmitting M. ulcerans to humans.

Loiasis: African eye worm.

The filarial parasite Loa loa is transmitted by Chrysops fly bites. Loiasis is endemic in rainforest areas of West and Central Africa, and sporadic cases have also been diagnosed in travellers and migrants. Whilst many infected persons are asymptomatic, microfilariae may be detected in the blood or adult worms may be seen under the skin or the sclera of the eye. Mass treatment programmes for onchocerciasis have raised concern about the risk of severe adverse effects when ivermectin is distributed in areas co-endemic for onchocerciasis and loiasis.