epidemiology of hepatits b and …...programmes in the european region who strengthening...
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WHO Regional Office for Europe
EPIDEMIOLOGY OF HEPATITS B AND
VACCINATION PROGRAMMES IN THE EUROPEAN REGION
WHO
Strengthening immunization systems and introduction of hepatitisB vaccine in Central and Eastern Europe and the Newly
Independent States, 3rd meeting, Kiev, Ukraine, 25-28 May 2004
Dr Nedret EmirogluRegional Adviser, Vaccine Preventable Diseases and Immunization,
WHO Regional Office for Europe
WHO Regional Office for Europe
Meetings on “Prevention and control of hepatitis B in CCEE and NIS”
Siofok, HUNGARY 1996 • First opportunity to raise awareness and put
Hepatitis B on the political agendaSt Petersburg, RUSSIAN FEDERATION 2001 • Substantial progress achieved• Major constraints and future actions identifiedKiev, UKRAINE 2004• PROGRESS, PROGRESS, PROGRESS!!!
WHO Regional Office for Europe
Percent Prevalence12 % (5)5% to 11% (6)2% to 5% (6)1% to 2% (6)
Estimated baseline prevalence rates of hepatitis B surface antigen, WHO/EURO, 1996
WHO Regional Office for Europe
Hepatitis B immunization in 1996
only 5 of the 25 countries
in Central and Eastern Europe and the Newly Independent States introduced,mainly because of economic constraints.
WHO Regional Office for Europe
Estimated baseline prevalence rates of hepatitis B surface antigen and routine hepatitis B immunization policy
WHO/EURO, 2000
Estimated baseline prevalence rates of hepatitis B surface antigen and routine hepatitis B immunization policy
WHO/EURO, 2000
<1%1-5%>5%
no data
Hatching denotes routine Hep. Bimmunization in 2000
Prevalence
WHO Regional Office for Europe
Countries implementing HepB WHO/EURO, 2000 (30)
• High endemicity (4)– Albania – Kazakhstan– Kyrgyzstan – Moldova
• Intermediate (5)– Belarus – Bosnia & Herzegovina– Bulgaria– (FYRO Macedonia)– Lithuania– Romania
• Low endemicity (21)– Andorra -Italy– Austria -Latvia– Belgium -Luxembourg– Czech Republic - Estonia – -Malta– France -Monaco– Germany -Poland– Greece -Portugal– Israel -San Marino– Slovakia -Spain– Switzerland -Turkey
WHO Regional Office for Europe
Countries with no universal programme WHO/EURO, 2000 (18)
• Low endemicity (12)– Croatia -Slovenia– Denmark -Sweden– Ukraine – Finland -Unit.
Kingdom– Iceland -Yugoslavia– Ireland– Netherlands– Norway
• High endemicity (5)– Azerbaijan – Georgia – Tajikistan – Turkmenistan – Uzbekistan
• Intermediate (1)– FYROMacedonia
WHO Regional Office for Europe
Progress since 2001 Where are we now ?
WHO Regional Office for Europe
Estimated baseline prevalence rates of hepatitis B surface antigen WHO/EURO, 1995-2003
High (>8%)
Intermediate (2-8%)
Low (1-2%)Very low (<1%)
No data
Source: Antwerp Center Survey + WHO data review for 1995-2003
WHO Regional Office for Europe
Incidence of Hepatitis B in the European Region 1990-2003
0
5
10
15
20
25
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
*
Inic
denc
e pe
r 100
,000
0100,000,000200,000,000300,000,000400,000,000500,000,000600,000,000700,000,000800,000,000900,000,0001,000,000,000
Popu
latio
n de
nom
inat
or
Incidence per 100,000 Population denominator
* Russia not reporting
WHO Regional Office for Europe
Hep B immunization policy WHO European Region, 1998
Universal infant
Universal newborn
Universal adolescentNo universal HepBimmunization
No data
WHO Regional Office for Europe
Hep B immunization policy WHO European Region, 2004
Universal infant
Universal newborn
Universal adolescentNo universal HepBimmunization
WHO Regional Office for Europe
BelarusBosnia & Herz. (Federation)
Newborn/infants + older children and adolescents 8:
GeorgiaKyrgyzstanLatviaLithuaniaMoldova
TajikistanTurkeyTurkmenistanUzbekistan
EstoniaKazakhstan
PolandRomaniaRussian Fed.Ukraine
HepB immunization schedules inCCEE and NIS, 2004
Newborn/infants 14:AlbaniaArmeniaAzerbaijanBosnia & Herz.(RS )Bulgaria
Infants 3:Macedonia Serbia & Montenegro Slovakia
Infants + adolescents 1:Czech Rep.
Adolescents 3:Hungary SloveniaCroatia
WHO Regional Office for Europe
Immunization coverage rates in the European Region, 1990-2002
0
10
20
30
40
50
60
70
80
90
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Cov
erag
e
DTP
Measles1
HepB3
BCG
WHO Regional Office for Europe
HepB3 coverage WHO European Region, 2000-2002
0102030405060708090
2000 2001 2002
Cov
erag
e (%
)
Regional coverage Coverage in countries with HepB immunization
WHO Regional Office for Europe
HepB3 coverage European Region WHO, 2003
Source: WHO/UNICEF joint reporting form as of 18/05/2004
0 - 8080 - 9090 - 95> 95
No data
WHO Regional Office for Europe
HepB coverage, birth dose European Region/WHO 2003
Source: WHO/UNICEF joint reporting form as of 18/05/2004
0 - 8080 - 9090 - 95> 95No birth doseNo data
WHO Regional Office for Europe
HepB3 coverage European Region/WHO by subregions, 2003
0
10
20
30
40
50
60
70
80
90
100
WesternEurope
CCEE NIS RegionTotal
DTP3HepB3
WHO Regional Office for Europe
Russia1st.shp0 - 5050 - 8080 - 9090 - 95>95No Data
Hepatitis B3 coverage in Russia by 12 months of age, 2001
WHO Regional Office for Europe
Russia1st.shp0 - 5050 - 8080 - 9090 - 95>95No Data
Hepatitis B3 coverage in Russia by 12 months of age, 2002
WHO Regional Office for Europe
Hepatitis B3 coverage in Russia by 12 months of age, 2003
Russia1st.shp0 - 5050 - 8080 - 9090 - 95>95No Data
WHO Regional Office for Europe
Major achievements -1
• Hepatitis recognized among health priorities• Hep B vaccine routinely used in most countries of
the Region (43/52) • All CCEE and NIS have HepB in immunization
schedules (26/29 target newborn and infants)• All high endemic countries provide birth dose• Immunization is free of charge • Staff well trained, capable and motivated
WHO Regional Office for Europe
Major achievements -2
• Increased political commitment and support • High demand from public for HepB immunization• Better partnership and collaboration between
MoHs and partners• Strengthened surveillance systems
– notification of acute hepatitis B is mandatory – some countries do have very complete data
• Increased understanding of the need for monitoring progress
WHO Regional Office for Europe
Major challenges• Economic and political instability in some countries• Inadequate allocation of resources from State funds• Unequal economic development of regions and districts within
countries• Accuracy of data collected (esp.birth dose)• Surveillance systems
– not well established or weak in some countries– methods used vary
• Limited monitoring and impact assessment• Lack of integration and interaction between highly-developed
private sector and PHC
• SUSTAINABILITY!!!!
WHO Regional Office for Europe
Priorities and future actions
• Advocacy to ensure political commitment and continued funding
• Technical support to sustain progress and improve implementation
• Building management capacity for monitoring performance at district level, with timely and adequate response
• Strengthening surveillance systems, improving quality of data
• Assessment of the programme and monitoring impact • Communication and advocacy with all stakeholders
through provision of evidence and information
WHO Regional Office for Europe
Thank you…