Dr irma asuncion hb liver ca summit

A PROGRESS REPORT ON THE CONTROL OF HEPATITIS B

IN THE PHILIPPINES

Disease Burden

>12% prevalence of chronic Hep B infection

HB Control Targets

Hepatitis B is a priority

• In 2005, countries in the Western Pacific Region including the Philippines aimed to:

Milestone : Reduce the prevalence of chronic HBV infection to <2% among children aged ≥5 years by 2012

Goal: Reduce the prevalence to ≤ 1% among children ≥5 years by 2017

Strategies to Achieve the Goal

•High coverage of 3 doses of hepatitis B vaccine (HepB3), with a birth dose given within 24 hours of birth

•Measuring the prevalence of chronic HBV infection by conducting representative seroprevalence surveys;

•Verifying achievement of a reduced prevalence of chronic HBV infection by submitting country-level data to be reviewed by a regional verification panel.

Strategy 1: Hepatitis B vaccination

• ≥65% timely birth dose coverage defined as within 24H after birth

• ≥ 85% three (3) dose of Hepatitis B vaccine coverage

Immunization Schedule for Infants

AntigenAGE

At birth 1 ½ mo 2 ½ mo 3 ½ mo 9mo 12mo

BCG √

HepB √

DPT-HepB-Hib √ √ √

OPV √ √ √

Rota √ √

Measles √

MMR √

THE MANDATE….

Time Band: 90minutes to 6hrs

Intervention: Inject HepB and BCG

…..Hepatitis B immunizationin the PhilHealth Newborn Package…

WHAT HAS BEEN DONE?

Strategy 2: Measure Impact-1

•Field assessment of the hepatitis b birth dose practices in health facilities in 2011

• Done in 8/17 regions in the country

• 142 health facilities were assessed (health centers , lying-in clinics, public & private hospitals with deliveries)

Strategy 2: Measure Impact-2

• National Hepatitis B Seroprevalence Study in 2013 • 1st Hepatitis B seroprevalence survey conducted in the Philippines

among children

• Objectives• Primary: To determine the seroprevalence of HBsAg among 5-6

year old children.

• Secondary: To evaluate the HepB vaccination effectiveness by reviewing the HepB vaccination coverage including timing of the first dose along with the seroprevalence of HBsAg in the sampled population

Strategy 2: Measure Impact-2

• National Hepatitis B Seroprevalence Study in 2013

• Sample population were children born between January 1, 2007- December 31, 2008

• 3000 children aged 5-6 years old •

•RESULT will be available SOON……

Strategy 3: Verification of Reduced Prevalence of chronic Hep B Infection

• Country notify WHO readiness for the verification process• Submits evidences that the prevalence of chronic hepatitis

reduced.

HBV prevalence among blood donors and OFWCs* (2002-2004)

HBsAg

Number Tested

Number positive

%

Blood Donors

Male 59,740 2,551 4.27

Female 5,214 153 2.93

All 64,954 2,704 4.16

OFWs

Male 30,484 1,374 4.51

Female 49,186 1,952 3.97

All 79,670 3,326 4.17* Yanase, Gill, et. al

HBsAg positivity rates among clients of Laboratories Participating in EQAS of NRL – SACCL

(2010-2012)

Year HBV Total Tested HBV(+) %+ #lab

2012 2,206,310 99,184 4.49 1019

2011 1,936,046 97,814 5.05 789

2010 1,712,645 90,052 5.25 429

Census of Natioanl Reference Lab – STD AIDS Cooperative Laboratory

What has been done. . .

Guidelines for the Implementation of a Workplace Policy and Program on Hepatitis B (DOLE)

All establishments are encouraged to provide mandatory HepB vaccination to employees– Required for healthcare workers and high-risk individuals

• Individuals with HepB should not be declared unfit to work without medical evaluation, nor terminated on the basis of HepB status

• confidentiality, referral system in the workplace• Screening for HepB as pre-requisite for employment shall not be

mandatory• Those who contract HepB in the course of their duty are entitled of

Health benefits under SSS and Employees Compensation Benefits under PD 626

• IEC on hepatitis

https://dl.dropbox.com/u/84112124/Department%2520Advisory%2520No.%252005%2520%28Corrected%2520Copy%29%5B1%5D.pdf

What has been done. . .

• Policy on Post Exposure Management (PEM) for HIV, Hepatitis B & C in Healthcare Settings (DOH) – Technical Guide

• All hospitals shall include Hepatitis B and C into existing HIV awareness campaign by HACT or ICC

• New entrant health care personnel in clinical and ancillary departments shall be required to undergo mandatory Hep B vaccination

• All cases of accidental exposures should be reported to ICC for a decision to commence PEP

• Policy on Post Exposure Management (PEM) for HIV, Hepatitis B & C in Healthcare Settings

• What has been done. . .

• Guidelines and packages which help assist service providers and managers including safety, quality and availability of blood are available

• Infection control guideline -prevention of hepa B and other diseases in the health care setting

• Persons with active chronic Hep B and HIV can now benefit new treatment with anti-retrovirals

Action Points

Action Points

Action Points

• Increase awareness and knowledge on hepatitis including that of health care workers integrated with other health promotion activities

• Enhance Planning and working with partners

•

• Challenges

• surveillance systems for HepB – basis for evidence-based policy actions

• People Who Inject Drugs - horizontal and vertical transmission

• Many chronically infected individuals are unaware of their Hep B status

• Behavior change

•Enforce restrictions on smoking in public places and near schools based on the Tobacco Regulations Act•Enforce restrictions on selling tobacco products based on the Tobacco Regulations Act

• Enforce restrictions on selling alcohol to minors

• Grant access to lands that the community can use as pocket farms to grow fruits and vegetables

• Hold community feeding programs to teach children the value of nutritious food• Hold lectures for mothers to teach them how to prepare healthy yet inexpensive food

• Provide courts and facilities that can serve as venue for physical activities

• Host sports fests that will foster healthy competition and sportsmanship

• Hold a community exercise program to in partnership with local gym or fitness center instructors?

Support Healthy Lifestyle Programs

Thank you for your attention. . .