Hepatitis in Mongolia
Mongolia has one of the highest rates of viral hepatitis in the world leading, to the highest rate of liver cancer (HCC) in the world. More than 77% of the Mongolian population is estimated to have been infected with hepatitis B virus (HBV) at some time during their life, and between 10% and 22% of the general population is chronically infected with either hepatitis B or C. Additionally, as many as 67% of patients with HBV are reported to also have hepatitis D.
Viral hepatitis infections can be prevented through administering vaccines (hepatitis A, B, and E), improvement of hospital infection prevention and control procedures and education of the general population. Hepatitis B virus vaccine is the only vaccine known to prevent liver cancer. Mongolia was one of the rst countries to introduce hepatitis B vaccine into routine immunization schedules for newborns and children under 1 year old in 1991.The vaccine consists of three doses as recommended by the World Health Organization (WHO). Despite Mongolia’s large nomadic population, an estimated 99% of newborns receive the rst dose of the vaccine within 24 hours of birth. The incidence of viral hepatitis B has decreased substantially since the vaccination was introduced. However, viral hepatitis B and C are still high among populations over 40 years old.
Chronic viral hepatitis C can now be cured with a recently released 3-6 month drug treatment.There are also treatments, but not yet a cure, for hepatitis B. However, most people in Mongolia do not have access to treatment due to a lack of screening and clinical services, and the high prices of hepatitis medicines. Even with an almost 90% reduction in the cost of hepatitis B and C treatment medications by Gilead in Mongolia, these medications are still unaffordable for most Mongolians.
Chronic viral hepatitis infections are responsible for an estimated 57% of liver cirrhosis and 78% of primary liver cancer. Studies have shown that 93% of liver cancer patients in Mongolia are also infected with hepatitis. Mongolia is also recorded to have six times the global average of liver cancer. One in 10 deaths in Mongolia is reported to be caused by liver cancer. Liver cancer accounts for 38.5% of all cancer in Mongolia and 43.8% of all cancer deaths. 78% of liver cancer is not diagnosed until stage III or IV. 85% of liver cancer patients die within one year of receiving the diagnosis.The majority of treatment for liver cancer in Mongolia is currently palliative care.
The rate of liver cancer in Mongolia is due largely to the late diagnosis of hepatitis. All types of viral hepatitis infections serve as a source of great health and financial loss for the entire population. Earlier diagnosis of hepatitis will prevent liver cancer. Earlier diagnosis of both hepatitis and liver cancer in Mongolia will save lives.