“The Hadassah Medical Organization’s greatest contributions to the global battle against hepatitis are the vaccines that have been developed here,” notes the former director of Hadassah’s Liver Unit, Prof. Daniel Shouval, as we mark World Hepatitis Day on July 28. In addition, innovative treatments at Hadassah have aided in the fight against this global burden.
Prof. Shouval currently serves as a hepatitis expert for the World Health Organization (WHO) and on the European Viral Hepatitis Prevention Board. This board is comprised of 10 volunteer physicians who travel the world to advise local doctors and health administrators on best practices.
One of the largest public health threats of our time, viral hepatitis takes the lives of 1.34 million people each year. World Hepatitis Day, observed annually on July 28, aims to bring the world together to raise awareness about hepatitis and to encourage prevention, diagnosis, and treatment. Thanks to Hadassah’s vaccines and treatments, the lives of millions in Israel and throughout the world have been improved.
The ABC’s of Hepatitis
Under the leadership of Prof. Shouval, Hadassah developed the vaccine for Hepatitis A and continues to contribute to vaccine strategy and best practices.
“One of our first clinical trials for the Hepatitis A vaccine was conducted with the ultra-Orthodox Satmar Hassidim in Monsey, New York,” relates Prof. Shouval. “We received special permission from the U.S. Food and Drug Administration because there was an epidemic there in 1988. Hepatitis A spreads through touch and bodily fluids; the high birth rates and close living quarters among the Satmar population meant that the disease spread like wildfire. We sat with the Satmar Rabbi and his wife and convinced them of the importance of this vaccine. Despite their previous objections to clinical trials, they agreed to participate and directed all children in Satmar schools to take part. Over 1,000 children were vaccinated and the epidemic was stopped within three weeks of giving these vaccinations.”
Prof. Shuval adds that in 1988, 300,000 people in China were infected with Hepatitis A. “This triggered the global search for a vaccine,” he explains. “The Chinese Department for Vaccines within the Chinese Centers for Disease Control,” he says, “is currently directed by a former student of mine. He studied at the Hadassah-Hebrew University Braun School of Public Health and Community Medicine, and I see how he applies the lessons learned here to the lives of millions of Chinese.”
In 1999, Hadassah began vaccinating toddlers as young as 18 months—the first in the world to vaccinate at such a young age—because Hadassah researchers saw that the disease was being passed from the toddlers to their parents. Whereas before there were 70 cases of Hepatitis A in every 100,000 people, the vaccine successfully reduced the number to 2.4 cases. This strategy has since been adopted by 11 other countries, including the United States.
In 1992, Hadassah developed a vaccine for Hepatitis B, which passes from a mother to her baby. Israel became the first country to administer the vaccine on the first day of a child’s life. Before the creation of the vaccine, three to five percent of the Israeli population were Hepatitis B carriers. Thanks to the vaccine, only 0.4 percent of Israelis are carriers today. Worldwide, 350 million people have the Hepatitis B virus.
“Hepatitis B used to be one of the leading reasons for liver transplants,” reports Prof. Shouval. Since the development of this vaccine, the need for transplants due to hepatitis has dropped dramatically.
The most potent vaccine for Hepatitis B was recently developed by researchers at Hadassah and the Weizmann Institute of Science. Previous vaccines focused on targeting one type of protein surrounding the cell of the virus. The current vaccine attacks three different types of proteins, making this vaccine stronger, faster and more effective in combating Hepatitis B.
“The current vaccine enables the patient to develop antibodies in a matter of days, as opposed to a matter of weeks,” said Dr. David Hakimian, physician at Hadassah’s Institute of Gastroenterology and Liver Diseases. The vaccine is currently approved for use in 10 countries, including Israel, but is not yet widely available to the public. “There is now less room for worry. If Israel needs to send security or medical personnel to provide aid in another country, this vaccine is rapidly effective, ensuring our personnel are protected,” said Dr. Hakimian. “We also use this vaccine when treating complex patients and the elderly with a variety of health conditions. This new vaccine is proven to protect a patient who has a variety of health problems, including kidney failure and diabetes.”
Shuki Mizrachi already had three kidney transplants and years of dialysis after a rare genetic condition caused his kidneys to fail. At 42, his body was no longer able to undergo dialysis, and there were no healthy kidneys available for transplant. That’s when Hadassah nephrologist Dr. Keren Tzukert offered Mizrachi a chance to be the first Israeli patient to receive a kidney from a donor with Hepatitis C. “When you are drowning and someone offers you a life raft, you take it—even if there is a small hole,” said Mizrachi.
Mizrachi received antiviral medications to combat the Hepatitis C immediately following his kidney transplant. A year after the transplant, Mizrachi is still healthy with no sign of Hepatitis and a functioning kidney. Since then, three additional patients at Hadassah received kidneys from Hepatitis C positive organ donors.
Hadassah is one of the first medical centers in the world to perform an organ transplant from a donor with hepatitis. “The success of antiviral medications in combating Hepatitis C made such transplants a viable option,” said Professor Rifaat Safadi, Head of Hadassah’s Liver Unit. “Without this, the kidneys would, of course, have been rejected. Our patients lives were saved.”
Hadassah was also one of the first medical centers in the world to use antiviral medications in combatting Hepatitis C. This option was introduced in 2014, and those antivirals have improved and proven to be a potent response to the disease. Previous treatment of Hepatitis C included injections of interferon. Those injections were painful, and often ineffective.
Hadassah participated in the international clinical trial for the development and FDA approval of antiviral medications in the treatment of Hepatitis C. “Hadassah summarized the Israel experience and our real-life results were comparable to the expected, published data,” said Professor Safadi. “This added credibility.”