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Hepatitis ‘B’ Infection in

General Population
MPH314-Communicable and Non-
Communicable Diseases
By;
Dr. Muhammad Bilal Khan
Roll No:16
Types of Viral Hepatitis
A B C D E
Source of virus Feces Feces
Blood/blood- Blood/blood- Blood/blood-
derived body derived body derived body
fluids fluids fluids

Route of Fecal-oral Percutaneous Percutaneous Percutaneous Fecal-oral


transmission permucosal permucosal permucosal

Chronic No Yes Yes Yes No


infection

Prevention Pre/post- Pre/post- Blood donor Pre/post- Ensure safe


exposure exposure screening; risk exposure drinking water
immunization immunization behavior immunization;
modification risk behavior
modification

Source: Center for Disease Control and Prevention (CDC)


HBV and HCV Pose
an Even Greater
Risk Then HIV

Source: Centers for Disease Control and Prevention, 1991


%age of Blood Borne Infection
Due to Contaminated Inj.
Contaminated Injections

50%
40%
40%
%age of cases

32%
30%

20%
10% 5%

0%
HBV HCV HIV
Type of Infection

PMRC
Bloodborne Pathogens
Hepatitis B
DEFINITION

Hepatitis B is a potentially life-


threatening liver infection caused by
the hepatitis B virus & causes both
acute and chronic disease. It can
cause chronic liver disease and put
people at high risk of death from
cirrhosis of liver and cancer
Introduction HBV
 1st time Lurman described in 1885 AD
 DNA Virus (Double Shelled)
 Affects only man & Champanzee
(primate).
 Destroys if boiled at 1000 C for 1
minute.
 Incubation Period = 2-5 months.
 Can be prevented though vaccination.

Source:Pakistan Research Repository, HEC,Gov. of Pakistan.


Hepatitis B Virus

The virus is
transmitted
through blood
and other body
fluids of an
infected person-
not through
casual contact

CTLT by CDC
Concentration of Hepatitis B Virus
in Various Body Fluids

Low/Not
High Moderate Detectable

blood semen urine


serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk

CDC
Common Modes of
Transmission in Developing
Countries
 Perinatal (from mother to baby at birth)
 Early childhood infections (inapparent
infection through close interpersonal
contact with infected household contacts)
 Unsafe injections practices.
 Blood transfusions
 Sexual contact.
Key Determinants
 Age
 Gender
 Place
 Socio economic status
 Pregnancy
 Occupation
 Immunodeficiency
Natural History of Hepatitis
B

CTLT-CDC
Geographic Distribution of Chronic
HBV Infection

Hepatitis B
virus
infection is a
major global
health HBsAg Prevalence
problem and ≥ 8% - High
the most 2-7% - Intermediate
serious type <2% - Low
of viral CDC
hepatitis
Global Patterns of Chronic HBV
Infection
 High (³8%): 45% of global population
– lifetime risk of infection >60%
– early childhood infections common
 Intermediate (2%-7%): 43% of global
population
– lifetime risk of infection 20%-60%
– infections occur in all age groups
 Low (<2%): 12% of global population
– lifetime risk of infection <20%
– most infections occur in adult risk groups
CDC
Magnitude of the Problem
 World wide an estimated two billion people
have been infected with hepatitis B (HBV)
virus
 more than 350 million have chronic (long-
term) liver infection
 Hepatitis B is 50 – 100 times more
infectious than HIV
 250 million Hepatitis B cases reside in Asia
 Hepatitis B is endemic in China and other
parts of Asia. (Prevalence is 8%-10%)
 Middle East and Indian sub-continent, an
estimated 2% to 5% of the general
population is chronically infected
Situation in Pakistan
 Endemic Disease
 HBV prevalence is 2.5 %
 Age <10 Yrs is 10% of all hepatitis.
 WHO study showed Pakistan has 13.6
injection/person/year
 AKU and PMRC studies showed 13&14 inj
 WHO allows 3.5 injections/person/year
 Pakistan has the highest therapeutic use of
injection world wide
 In Pakistan, the estimate is 4.5 million carriers
with a carrier rate of 3-4%.
 The higher is the injection use the higher
is chance of blood born infections
WHO & PMRC
Prevalence of HBV in
Pakistan
I. Provincial Status

4.30%
%ages

2.50% 2.40%

1.30%

Balochistan Sindh NWFP Punjab


Provinces

PMRC
Existing Policies and
Organizational Capabilities
 EPI: Vaccination against HBV in <1yr
 Prime Minister’s Program for
Prevention and control of
Hepatitis:
– Launched in August 2005 (Actually started
January 2006)

– Total cost 2594.00 Millions


– Duration 5 years

PM’sHP&CP ,NIH
Prime Minister’s Program for
Prevention and control of
Hepatitis
 Major Objective of the Program were:
– Hepatitis B vaccination for high risk
groups
– Strengthen of Routine EPI
– Safe injection, Blood transfusion and
other invasive medical devices with
proper SWM.
– Surveillance Diagnostic Lab services
and Epidemic response for Hepatitis
infection
– Advocacy and BCC strategy
development PM’sHP&CP ,NIH
Prime Minister’s Program for
Prevention and control of
Hepatitis
 Major Achievements till date
– 473640 against target of 425000 high risk persons
vaccinated
– 25000000 Disposal syringes provided to 151 sentinel
sites (Additional 1143310 syringes also given)
– Hospital Waste management system established in 48
Districts out of 120 target Districts.
– 50 out of 150 target, autoclaves provided for effective
sterlization
– 151 Teaching and DHQ hospitals have been equipped
with requisite laboratory equipments, kits & reagents,
consumables, medicines/Biologicals, hepatitis B vaccine

PM’sHP&CP ,NIH
What Else to do??

Protecting one
self from
estimated risks
and preventing
the future loss
by working
upstream
Aim & Objectives
Aim
Elimination of HBV from Pakistan

Objectives:
 To vaccinate 99% of the high risk
groups among the general population
of Pakistan in 05 Years.
 To give awareness in 95-98% of general
population in 05 years regarding the
vaccination against HBV.
Rationale of the
Intervention
 For HBV control more active
vaccination program needs to be
launched especially in the high
prevalence districts.
 95% of the HBV infections can be
prevented through vaccination.

(PMRC)
Interventions For the
Prevention & Control of
Hepatitis B In General
Population

Two strategies

 Prevention
 Control
Strategies……
 Preventive Strategy:
– Strengthening of Routine EPI Program
 To improve drop out coverage
 Separate catch up activities to vaccinate
drop out children
– Supporting existing PM’s prog. for
HP&C by
 Vaccination of high risk groups
– Occupational Groups (Doctors, Nurses,
Lab. Technicians etc)
– Pregnant women
– Sex worker & IDU users
– Patients on Dialysis
Strategies……contd..
– Mass vaccination of the general
population by
 Mandatory vaccination of school
and college students
 Mandatory vaccination for
employees
– Public employees
– Private employees
– Army
 Mandatory vaccination for
pregnant women during ANC
Strategies……contd..
 Control Strategies:
– Vaccination promotion campaign using;
 IECs
 Mass Media
 Community awareness sessions
 Involvement of the pvt. Sector.
– Hepatitis B vaccination would be
mandatory for immigrants
– Promoting safe necessary injection
practices
– Involvement of stakeholders
Evaluation of the Interventions
 Process Evaluation
– % of the stake-holders involved.
– IEC material printed & distributed
in time.
– % of fixed centres received
vaccine in time.
– Staff Hired in time.
– Equipments procured and
distributed in time.
– Were IEC material useful?
Outcome Evaluation
 Prevalence of Hepatitis B infection
 % of children covered for HBV
 Drop out rate for HBV
 % of High risk Group vaccinated
 % of School and college students
vaccinated
 % of employees vaccinated
 % of pregnant women vaccinated
 Case Fatality rate due to HBV infection
 % of General population vaccinated
 % of immigrants with Hepatitis B
infection
 Carrier rate for Hepatitis B vaccine
Impact Evaluation

 % of Population aware about


Hepatitis B infection and its
vaccination
 % of population coming for
vaccination to the fixed centers
Budget Estimates
 Total Estimated Cost 30 Billions
 Vaccine Purchase 18 Billions
 Salaries 5 Billions
 Procurement 2 Billions
 Monitoring & Evaluation 3
Billions
 Health Promotion
campaign 2 Billions
LIFEISNOWHERE
Life is no where?
OR
Life is now here!!
THANKS