Epidemiology and Control Epidemiology and Control Programs for HBV Infection. Programs for HBV Infection.

Yousef Qari, MD, FRCP(C), ABIMYousef Qari, MD, FRCP(C), ABIM

GastoenterologistGastoenterologist

King Abdulaziz University HospitalKing Abdulaziz University Hospital

Epidemiology of Hep B WorldwideEpidemiology of Hep B Worldwide

2 billion people are infected with this virus2 billion people are infected with this virus

350 million Chronic HBV infection.350 million Chronic HBV infection.

10th leading cause of death in the world10th leading cause of death in the world

Route of Transmission of HepBRoute of Transmission of HepB

High endemicityHigh endemicity– Perinatal (vertical)Perinatal (vertical)– Acquired in preschool years.Acquired in preschool years.

Low endemicityLow endemicity– Early adult lifeEarly adult life

Intravenous drug use Intravenous drug use Unprotected sexual activitiesUnprotected sexual activities

Worled Prevalence of Hep BWorled Prevalence of Hep B

Based on pooled data from surveys in Based on pooled data from surveys in Saudi Arabia up to 1988Saudi Arabia up to 1988

PROVINCEPROVINCE NUMBER OFNUMBER OF

MALESMALES

TESTEDTESTED

% POSITIVE% POSITIVE NUMBER OFNUMBER OF

FEMALES FEMALES

TESTEDTESTED

% POSITIVE% POSITIVE

CentralCentral 21552155 6.96.9 44944494 4.14.1

SouthwestSouthwest 15931593 13.813.8 56425642 3.93.9

EasternEastern 78387838 1111 462462 8.28.2

The prevalence of HBsAg and other markers The prevalence of HBsAg and other markers

of HBV among residents of Jizanof HBV among residents of Jizan

5.4 5.1

9.7

0.9

0

2

4

6

8

10

12

Blood doners14,883

Communityvolounteers

1172

Inpatients 4,692

Children 229

% w

ith

po

siti

ve H

BsA

g

Ayoola AE Saudi Med J.  2003; 24(9):991-5

HBV and HCV prevalence among dialysis HBV and HCV prevalence among dialysis patients in Bahrain and Saudi Arabiapatients in Bahrain and Saudi Arabia

5.88

9.24

0

2

4

6

8

10

12

14

16

18

20

Hemodialyss

% o

f p

ati

en

ts

HBV

HCV

Qadi AA Am J Infect Control.  2004; 32(8):493-5 (ISSN: 0196-6553)

A chronology of hepatitis BA chronology of hepatitis Bprogrammes in Saudi Arabiaprogrammes in Saudi Arabia

PROGRAMME TYPE YEAR OF IMPLEMENTATIONPROGRAMME TYPE YEAR OF IMPLEMENTATION

MandatoryMandatory All newborns (0-1 year) 1989All newborns (0-1 year) 1989 Children at school entry (6-7 years) 1990Children at school entry (6-7 years) 1990

VoluntaryVoluntary Pre-school children (1-5 years) 1990 / 1991Pre-school children (1-5 years) 1990 / 1991 Health personnel (adults) 1990Health personnel (adults) 1990 Others 1989Others 1989

HBV prevalence had declined among Saudi children eight HBV prevalence had declined among Saudi children eight years after the integration of the hepatitis B vaccine into the years after the integration of the hepatitis B vaccine into the national EPI.national EPI.

Al-Faleh FZ et al, B. J Infect 1992; 24;197-206.Al-Faleh FZ et al.. J Infect 1999; 38:167-170.

The decline of hepatitis B viral infection in South-The decline of hepatitis B viral infection in South-Western Saudi Arabia.Western Saudi Arabia.

12

5.1

8.8

0.90

2

4

6

8

10

12

14

1985 1998

Adults

Children

Ayoola AE Saudi Med J.  2003; 24(9):991-5 

Prevalences of HBsAg and anti-HCV among Saudi donors Prevalences of HBsAg and anti-HCV among Saudi donors before and after the adoption of the revised AABB blood before and after the adoption of the revised AABB blood

donation guidelines.donation guidelines.

Clinical and Diagnostic Laboratory Immunology, November 2003, p. 1159-1160, Vol. 10, No. 6

Prevalence of HBV, HCV among blood donors in a Prevalence of HBV, HCV among blood donors in a teaching hospital in the Central region of Saudi Arabia.teaching hospital in the Central region of Saudi Arabia.

1.5

0.4

0

1

2

3

4

5

6

7

8

9

10

HBV HCV

Blood Doners

% o

f p

ati

en

ts

24000 patients

El-Hazmi MMSaudi Med J.  2004; 25(1):26-33 

There has also been a significant decline of HBV markers among unvaccinated Saudi adults

Declining HBsAg prevalence in asymptomatic adults in Gizan (%)

19851985 19921992 19971997

MalesMales 19.919.9 9.49.4 5.85.8

FemalesFemales 9.39.3 6.16.1 4.24.2

TotalTotal 13.913.9 7.77.7 5.15.1

Hepatocellular carcinoma in Saudi Arabia: Hepatocellular carcinoma in Saudi Arabia: Role of hepatitis B infection.Role of hepatitis B infection.

6.7%

67%

0

10

20

30

40

50

60

70

80

90

100

HCC Healthy control

% o

f H

Bs

Ag

po

sit

ivit

y

Prevalence of HBsAg in patients with HCC & Healthy control

N=118 N=118

Ayoola EA J Gastroenterol Hepatol.  2004; 19(6):665-9 

1.9 per 1000

(2.3 in men, 1.2 in women).

Natural History of Hep BNatural History of Hep B

HBV Infection

Chronic HepatitisCirrhosis

HCC

15-40%

HBV

The real challengeThe real challenge

To decrease the incidence of HCC in our To decrease the incidence of HCC in our population by decreasing the prevalence population by decreasing the prevalence of Hepatitis B.of Hepatitis B.

ConclusionConclusion

According to the EPI programmes, all Saudi According to the EPI programmes, all Saudi citizens under the age of 26 years should have citizens under the age of 26 years should have been vaccinated by the year 2008.been vaccinated by the year 2008.

The low prevalence of HBsAg in children, The low prevalence of HBsAg in children, provides evidence for the effectiveness and provides evidence for the effectiveness and efficacy of the integration of hepatitis B efficacy of the integration of hepatitis B vaccination into the extended program of vaccination into the extended program of immunization in KSA.immunization in KSA.

ConclusionConclusion

The significant decline of HBV markers The significant decline of HBV markers among unvaccinated Saudi adults among unvaccinated Saudi adults indicated an indirect effect of other factors indicated an indirect effect of other factors like health education and socio-economic like health education and socio-economic progressprogress

The ongoing program of HBV vaccination The ongoing program of HBV vaccination may significantly decrease the prevalence may significantly decrease the prevalence of HBV-associated HCC in Saudi Arabiaof HBV-associated HCC in Saudi Arabia