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Prevention and control of Hepatitis B

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

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Prevention and control of Hepatitis B

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  1. Prevention and control of Hepatitis B In Central and Eastern Europe and Newly Independent States WHO/EURO

  2. “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

  3. 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

  4. Average annual incidence reported • per 100 000 population, 1996 Legend: 0.5 - 4 4.1 - 7.5 7.5 - 20 21 - 40 41 -120 Source WHO/EURO

  5. 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%

  6. Hepatitis B Carrier Prevalence,1996 Percent Prevalence 12 % (5) 5 % to 11 % (6) 2 % to 5 % (6) 1 % to 2 % (6)

  7. Hepatitis B Immunization schedulesWHO/EORO, 1996 UNIVERSAL Uni INFANT Uni. INF + ADOS Uni.ADOS Consideration Selective Source WHO/EURO

  8. Hepatitis B Implementation only 5 of the 25 countries in Central and Eastern Europe and the Newly Independent States had implemented, mainly because of economic constraints.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. Progress since 1996...

  14. Estimated baseline prevalence rates of hepatitis B surface antigen and routine hepatitis B immunization policy among Member States of WHO European Region, 2000 Prevalence Hatching denotes routine Hep. B <1% immunization in 2000 1-5% >5% no data

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

  16. Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)CCEE and Turkey * As of 1998; ** as of 1995;

  17. Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)Newly Independent States and RF * As of 1998;

  18. Incidence Rate of new hepatitis B cases, 1999 (per 100,000 population)EU countries * As of 1998; ** as of 1997;

  19. Routine hepatitis B immunization policy among Member States of WHO European Region, 2000 Universal imm Universal+ screening Risk groups Children born HBs(+) mother Adolescent

  20. Number of countries implementing universal Hepatitis B and immunization coverage, WHO/EURO, 1990-1999

  21. 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 Hepatitis B immunizationImplementation in CCEE & NIS,2000

  22. High endemicity (5) Armenia (GF) Azerbaijan (GF) Georgia (GF) Tajikistan (GF) Turkmenistan (GF) Intermediate (1) Russian Federation Low endemicity (2) Hungary Yugoslavia No Hepatitis B immunization programme, CCEE & NIS, 2000

  23. 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

  24. 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)

  25. 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

  26. 81-100% < 80% < 50% Data not available No universal immunization Hepatitis B immunization coverage, WHO/EURO, 1998-1999

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

  28. Reported Hepatitis B cases, Russian Federation, 1980-2000

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

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

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

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

  33. Conclusion • Main challenges • sustaining immunization services • increasing coverage • logistics and cold chain • safety of injections • monitoring performance • evaluation of impact

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