Prevention and control of hepatitis B in Central and Eastern Europe and the Newly Independent States. (October 1996)

Source : Siofok Report (see publications)

1. Consensus Statement

1.1 Hepatitis B is a disease of global importance. More than 350 million people are chronically infected with hepatitis B virus (HBV). Chronic liver disease and liver cancer related to HBV are significant causes of illness and death. More than one million people die each year from the consequences of chronic infection with the virus. World-wide, prevention and control of hepatitis B virus infection have become a major priority especially since safe and effective vaccines have been available for more than a decade.

1.2 In central and eastern Europe and the Newly Independent States all levels of HBV endemicity are found, but most of the population of the Region lives in areas of intermediate or high endemic levels. The WHO Regional Office estimates that more than one million people in the WHO European Region acquire acute hepatitis B infection each year, with most cases in the Newly Independent States. Nosocomial infection is a significant problem in the Region. Several countries in the Region consider hepatitis B to be the most significant infectious disease problem that they are facing and the leading cause of death among vaccine-preventable diseases. Hepatitis B vaccination is regarded as one of the most cost-effective health interventions.

1.3 In 1991 the Global Advisory Group of the Expanded Programme on Immunisation (EPI) of the WHO called for all countries to include hepatitis B vaccine in their national immunisation programmes by 1997. Hepatitis B vaccine is now considered to be the seventh universal antigen in the EPI. Routine immunisation of infants is recommended for countries with a chronic HBV prevalence of 2% or higher and countries of lower endemicity have the option to implement immunisation of adolescents instead of or in addition to infant immunisation. So far, more than 80 countries have included hepatitis B vaccination in their national programmes. However, only five of the 25 countries in central and eastern Europe and the Newly Independent States have yet done so, mainly because of economic constraints.

1.4 In addition to routine immunisation of infants, important measures for the prevention of hepatitis B include: ensuring safe injection and proper sterilisation of medical and dental equipment; proper screening of blood; protection of health-care workers through vaccination and adoption of standard precautions against infections acquired through contact with blood; and immunisation of people at high risk in the general population. Some countries lack systematic or functioning programmes for the screening of blood and are not ensuring safe injection practices.

2. General Recommendation

2.1 The participants at the meeting strongly support the WHO recommendation that routine hepatitis B immunisation of children be integrated into all national immunisation programmes as well as the 1994 WHO global target calling for an 80% decrease in the incidence of HBV child carriers by the year 2001.

3. Recommendations to Countries

3.1 All countries should plan to integrate hepatitis B vaccination into their national immunisation programmes as soon as possible. Countries should secure commitment to immunisation against hepatitis B at all levels of the relevant sectors of government and should communicate this commitment to partners in development.

3.2 All countries should develop a national plan for the control of hepatitis B. This plan should:

  • summarise the current disease burden and disease-control programmes;
  • include a strategy for routine vaccination of all infants and high-risk persons;
  • contain provisions to prevent nosocomial transmission of HBV, including the assurance of a safe blood supply, safe injection practices and proper disposal of medical waste;
  • specify a timetable and resources needed to implement the control programme;
  • perform economic evaluation analyses;
  • improve surveillance; and
  • raise public awareness.

3.3 Countries should implement measures to prevent the transmission of HBV in health-care settings through contaminated needles and equipment, improper waste disposal, unsafe work practices, unsafe blood products and unnecessary invasive procedures.

3.4 Measures should be taken to ensure the safety of the blood supply. This should include an assessment of current testing capabilities and the strengthening of them if indicated. All donors of blood, blood products, and donated tissues and organs should be screened for hepatitis B surface antigen and donations that test positive should not be used.

3.5 Countries of the Region should recognise the need to implement hepatitis B control programmes, and urge the WHO Regional Committee to afford control of this infection high priority.

4. Recommendations to Partners in Development

4.1 Partners in development should assist all countries in the formulation and implementation of their national plans, including assistance in the procurement of vaccines, diagnostics, economic analysis, programme evaluation and training.

4.2 A working group should meet regularly to review progress on hepatitis B control in order to assure co-ordination and sharing of information on hepatitis B control activities in the Region. This working group should consist of representatives of member countries, the Viral Hepatitis Prevention Board, the Centres for Disease Control and Prevention, the WHO and other interested parties.

4.3 Those present at this meeting, which had a high level of participation, endorse 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 burdens, well established EPI programmes, a low per capita gross national product, and solid government commitments to hepatitis B prevention programmes.

4.4 The meeting participants strongly urge the Interagency Immunisation Co-ordinating Committee for the support of the EPI in the Newly Independent States to assist national hepatitis B prevention programmes by making funding of these programmes a high priority.

5. Recommendations to WHO

5.1 The WHO Regional Office for Europe should recognise that prevention and control of HBV infection are a major priority and should develop a regional plan.

5.2 WHO should elaborate a document setting out guidelines for national hepatitis B control plans, should disseminate this to countries in the Region and should provide assistance in developing and implementing these plans.

5.3 WHO should design protocols that will enable countries to estimate their disease burden due to HBV infection, to perform economic evaluation of hepatitis B vaccination, and to monitor the effectiveness of hepatitis B prevention and control programmes.

5.4 WHO should take a co-ordinating role in working with other partners in development to secure technical and programmatic support as well as funding for hepatitis B prevention programmes in the Region.

5.5 WHO should convene an inter-country meeting on procurement and quality control of hepatitis B vaccines.