The theme of World Hepatitis Day 2022 is ‘Bringing Hepatitis care closer to you’.
Commemorating World Hepatitis Day provides an opportunity to accelerate national and international efforts against the spread of hepatitis infection, encourage actions and engagement by individuals, partners and the public and highlight the needs for a stronger global, regional and national response.
Viral hepatitis is a serious public health problem that can cause chronic and potentially fatal complications including liver cancer.
The South-East Asia Region (SEAR) has an estimated 60 million people living with chronic Hepatitis B infection and an estimated 10.5 million persons with chronic Hepatitis C. It is estimated that 218 000 deaths occur due to viral hepatitis each year in the region with most being attributable to the chronic complications of Hepatitis B and C.
Sri Lanka, however, is reportedly a Hepatitis B low-prevalent country. Sample surveys have shown low prevalence of Hepatitis B even among high-risk groups such as persons living with HIV: 0.3% [National STD & AIDS Control Programme (NSACP) – December 2015] and prison inmates: 0.25% (Niriella 2015) and even among blood donors: 0.11% at the National Blood Transfusion Service [NBTS (2018)].
With the introduction of a safe and effective vaccine by the global research community in 1982, immunization against Hepatitis B became the major prevention strategy. In many countries, immunization resulted in prevalence rates of chronic infection among children falling to less than 1% from 8-15%.
The South-East Asian Region, meanwhile, has achieved significant advances in hepatitis prevention in line with the Regional Action Plan for Viral Hepatitis 2016-2021. For example, nine of the region’s 11 Member States have achieved coverage of more than 90% of the third dose of hepatitis B vaccine. Four countries of the Region – Bangladesh, Bhutan, Nepal and Thailand – have achieved the hepatitis B control targets. Almost all Member States have begun implementing strategies to address hepatitis specifically, with a focus on driving integrated, and coordinated action.
In Sri Lanka, Hepatitis B is a notifiable disease and all physicians treating hepatitis patients are responsible to send information to the national system.
Hepatitis B vaccination was introduced to Sri Lanka’s Expanded Programme of Immunization (EPI) schedule in 2003. Since then, all infants in Sri Lanka are receiving three doses of the Hepatitis B vaccines.
Data reported to the Epidemiology Unit of the Ministry of Health (Focal point for EPI activities in Sri Lanka), as well as immunization coverage surveys conducted at district level, suggest very high level of immunization coverage (the pentavalent vaccine which includes Hepatitis B had a coverage of 99% in 2019).
This is seen as a remarkable achievement for the health sector of a lower-middle income country such as Sri Lanka.
With a global initiative underway to eliminate viral hepatitis by 2030 and Sri Lanka reporting a low number of Hepatitis B infections annually and having sound infection prevention and control systems in the hospitals and public health sector, the potential for reaching the elimination target earlier than stipulated is high.
In this direction, Sri Lanka has taken major initiatives to keep the prevalence of Hepatitis B at a minimum rate aided by close monitoring of the strong technical body – the Advisory Committee for Communicable Diseases (ACCD) consisting of subject experts.
The country has also taken several policy decisions to conduct the ‘high-risk group vaccination approach’ with regard to adult Hepatitis B vaccination. The identified high-risk groups are healthcare workers, sex workers (including men having sex with men (MSM) and transgender), cancer patients, thalassemia patients, chronic kidney disease patients on regular hemodialysis etc. In the case of healthcare workers, they are screened and vaccinated before absorption to the service. All blood donors are also screened for Hepatitis B and C with quality assurance and all the positive donors are linked to treatment services. Sri Lanka follows 100% safe injection practices in all healthcare facilities.
To achieve the Sustainable Development Goal (SDG) target of reducing Hepatitis B prevalence further (the target is 0.1% in 2030) in children under 5 years of age, the need is to conduct the National Sero-survey on Hepatitis B prevalence which is planned for 2022.
On World Hepatitis Day (the birthday of Nobel Prize winning scientist, Dr. Baruch Blumberg who discovered the Hepatitis B virus), WHO Sri Lanka reiterates its commitment to support the Government to conduct the National Sero-survey and reduce new hepatitis infections, bring testing and treatment to all who need them, and accelerate progress towards a world in which viral hepatitis is no longer a public health threat.
(Source: WHO and Epidemiology Unit, Ministry of Health - Sri Lanka)
References
- Annual statistics Report-2018-National Blood Transfusion services- Sri Lanka
- Hepatitis B vaccines: WHO position paper; July 2017
- Hepatitis B; Fact sheet; July 2019; WHO
- Niriella, M. A., A. Hapangama, et al. (2015). "Prevalence of hepatitis B and hepatitis C infections and their relationship to injectable drug use in a cohort of Sri Lankan prison inmates." Ceylon Med J 60(1): 18-20
- Padmasiri E, Rajapaksa L, Jayakuru WS, Withana N. The prevalence of hepatitis B surface antigen in the Gampaha district. Ceylon Med J. 1995 Mar;40(1):10-3. PMID: 7781086.