Prevention and control of Hepatitis B

In Central and Eastern Europe and

Newly Independent States

WHO/EURO

“Prevention and control of hepatitis B in CCEE and NIS”Siofok, Hungary, 1996, VHPB, WHO, CDC

first opportunity to raise awareness on hepatitis B to discuss universal immunization with decision

makers. The aim was : to summarize available data, to identify needs to implement effective

programmes to underline main constraints

Situation in 1996 –1

The WHO Regional Office estimated more than one million people acquire acute hepatitis B infection each year, most cases in NIS

Approximately 90 000 became chronic HBV carriers

In CCEE and NIS, levels of HBV endemicity were at intermediate or high endemic levels

Legend:

7.5 - 20

0.5 - 4

4.1 - 7.5

Average annual incidence reported

per 100 000 population, 1996

Source WHO/EURO

21 - 40

41 -120

Epidemiology in Europe, 1996

The level of endemicity increased from north to south and from west to east, with carrier rates; – northwestern Europe < 0.1%

– midwestern Europe 0.1-0.5%

– southwestern Europe, 1-5%

– eastern Europe 2-7%

– central Asian Republics > 7%

Percent Prevalence

12 % (5)5% to 11% (6)2% to 5% (6)1% to 2% (6)

Hepatitis B Carrier Prevalence,1996

Hepatitis B Immunization schedulesWHO/EORO, 1996

Uni INFANT

Consideration

Uni.ADOS

Uni. INF + ADOS

UNIVERSAL

Selective

Source WHO/EURO

only 5 of the 25 countries

in Central and Eastern Europe and the Newly

Independent States had implemented,

mainly because of economic constraints.

Hepatitis B Implementation

Recommendations to Countries

All countries should plan to integrate hepatitis B vaccination into their national immunization programmes as soon as possible.

All countries should develop a national plan for control of hepatitis B.

This plan should:

summarize current disease burden include a strategy for routine

vaccination of all infants and high-risk groups;

specify a time table and resources needed to implement the control programme

Recommendations to partners

The participants endorsed the UNICEF/ WHO strategy, calling for support of the neediest countries in obtaining hepatitis B vaccine.

Support should be targeted to countries with; – high disease burden, – well established EPI programmes, – a low per capita gross national product, – solid government commitment to hepatitis B

prevention programmes.

Recommendations to WHO

elaborate guidelines for national hepatitis B control plans,

provide assistance in developing and implementing these plans.

monitor effectiveness of hepatitis B prevention and control programmes

play coordinating role in working with other partners to support implementation of national plans

Progress since 1996...

Estimated baseline prevalence rates of hepatitis B surface antigen and routine hepatitis B immunization policy

among Member States of WHO European Region, 2000

Estimated baseline prevalence rates of hepatitis B surface antigen and routine hepatitis B immunization policy

among Member States of WHO European Region, 2000

<1%1-5%>5%

no data

Hatching denotes routine Hep. Bimmunization in 2000

Prevalence

Incidence Rate of new hepatitis B cases, 1998/1999 (per 100,000 population)

Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)

CCEE and Turkey

0 5 10 15 20 25

Albania

B&H

Bulgaria*

Croatia

Czech Republic

Estonia

Hungary

Latvia

Lithuania

Poland

Romania

Slovak R.

Slovenia

The FYRM

Turkey

Yugoslavia, FR**

* As of 1998; ** as of 1995;

Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)

Newly Independent States and RF

0 5 10 15 20

Armenia

Azerbaijan

Belarus

Georgia*

Kazakhstan*

Kyrgyzstan*

Moldova*

RF*

Tajikistan*

Turkmenistan*

Ukraine

Uzbekistan*

* As of 1998;

Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)

EU countries

0 2 4 6 8 10 12 14

Austria*Belgium*

Denmark*FinlandFrance*

GermanyGreece*Ireland**

ItalyLuxembourg*Netherlands*

Portugal*Spain

Sweden*United Kingdom

* As of 1998; ** as of 1997;

Routine hepatitis B immunization policy among Member States of WHO European Region, 2000

Universal imm

Universal+ screening

Risk groups

Children born HBs(+) mother

Adolescent

0

20

40

60

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

0

10

20

30

40

50

% HepB3 # countries reported

Number of countries implementing universal Hepatitis B and immunization coverage,

WHO/EURO, 1990-1999

Hepatitis B immunizationImplementation in CCEE & NIS,2000

High endemicity (5)– Albania (GF)– Kazakhstan– Kyrgyzstan (GF)– Moldova (GF) – Uzbekistan (GF)– Intermediate (6)– Belarus

– Bosnia & H. (F)– Bulgaria– (FYROMacedonia):Risk group– Lithuania– Romania

Low endemicity (9)– (Czech Republic) Risk group

– (Croatia) Adolescents– Estonia:Born to HBsAg (+) mother

– Latvia

– Poland

– Slovakia

– Slovenia:Born to HBsAg (+) mother +Adolescents

– Turkey

– Ukraine:Born to HBsAg (+) mother

No Hepatitis B immunization programme, CCEE & NIS, 2000

High endemicity (5)– Armenia (GF)– Azerbaijan (GF)– Georgia (GF)– Tajikistan (GF)– Turkmenistan (GF)

Intermediate (1)– Russian Federation

Low endemicity (2)– Hungary– Yugoslavia

Hepatitis B Screening (survey + WHO/EURO database)

Screening of pregnant women:– universal screening recommended in 21

countries– 4 countries, selective screening– 7 countries no recommendation, because

of birth dose– 18 countries no information

Immunization Schedules, WHO/EURO, 2000

Neonatal: – 0, 8, 24 (4) / 0, 8, 20 wks– 0, 4, 24 (5)/ 0, 4, 20 wks– 0, 4, 8, 52 wks

Infant: – 12, 20, 40-48 wks– 12, 16, 20, 96 wks– 16, 20, 56 wks– 8, 12, 24 wks– 9, 13, 33 wks– 8, 12, 16, 44 wks

Adolescent: – 0, 1, 6 months (12/12)

Hepatitis B Risk group immunization (survey + WHO/EURO database)

Risk group programme: – information for 22/24 – 15/19 in addition to a universal programme– 6/19 risk group programme and no

universal programme– no risk group programme

Hepatitis B immunization coverage, WHO/EURO, 1998-1999

81-100%

< 80%

< 50%

Data not available

No universal immunization

Hepatitis B immunization coverage, by Member States, WHO/EURO, 1999

0 10 20 30 40 50 60 70 80 90 100

Albania

Andorra (1998)

Bosnia and Herzegovina

Bulgaria (1998)

Germany (1997)

Greece (1997)

Hungary

Israel

Italy

Kazakhstan

Kyrgyzstan

Latvia

Lithuania

Luxembourg (1997)

Malta (1998)

Poland

Portugal (1998)

Republic of Moldova

Romania

San Marino

Slovenia

Uzbekistan

Reported Hepatitis B cases, Russian Federation, 1980-2000

20,00025,000

30,000

35,000

40,000

45,000

50,000

55,000

60,00019

80

1982

1984

1986

1988

1990

1992

1994

1996

1998

no of cases

0

1000

2000

3000

4000

5000

6000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

# ca

ses

0

20

40

60

80

100

% c

over

age

# new cases % HepB3

Hepatitis B vaccination coverage & new cases, Kazakhistan, 1991-2000

0

250

500

750

1000

1250

1500

1750

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

# ca

ses

0

20

40

60

80

100

% c

over

age

# new cases % HepB3

Hepatitis B vaccination coverage & new cases, Kyrgyzstan, 1991-2000

0

500

1000

1500

2000

2500

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

# ca

ses

0

20

40

60

80

100

% c

over

age

# new cases % HepB3

Hepatitis B vaccination coverage & new cases, Republic of Moldova, 1991-2000

0

1000

2000

3000

4000

5000

6000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

# ca

ses

0

20

40

60

80

100

% c

over

age

# new cases % HepB3

Hepatitis B vaccination coverage & new cases, Turkey, 1991-2000

Conclusion

Main challenges– sustaining immunization services– increasing coverage– logistics and cold chain– safety of injections– monitoring performance– evaluation of impact