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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
50%
40%
40%
%age of cases
32%
30%
20%
10% 5%
0%
HBV HCV HIV
Type of Infection
PMRC
Bloodborne Pathogens
Hepatitis B
DEFINITION
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
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%
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)
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