prevention and control of hepatitis b in central and eastern europe and newly independent states...
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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