viral hepatitis

121 Pages·2013·1.08 MB·English

Viral hepatitis is a serious public health problem worldwide, as well as for the Member States of
the WHO South-East Asia Region. The complexity of hepatitis disease lies in the existence of
different types of viruses. Hepatitis A and E are foodborne and waterborne infections that cause
millions of cases of acute illness every year. Hepatitis B, C, and D are spread in a number of
ways, namely by receiving unscreened blood and blood products, sexual contact, mother-to-
child transmission during birth, or through use of contaminated medical equipment. Hepatitis B
and C have a greater health burden and a high mortality related to chronic infection, which in
turn can lead to cirrhosis and liver cancer. Considering the importance of prevention and
control of viral hepatitis, the WHO Regional Office for South-East Asia, together with active
participation of the representatives of the Member States has developed a regional strategy for
Regional strategy
prevention and control of viral hepatitis. The goal of the strategy is to implement policies,
programmes and interventions to interrupt transmission and reduce the incidence and the
socioeconomic consequences of viral hepatitis in the Region. for the prevention
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www.searo.who.int SEA-CD-282

SEA-CD-282
Distribution: General
Regional strategy for the
prevention and control of
viral hepatitis
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Contents
Abbreviations ........................................................................................................vii
Executive summary .................................................................................................ix
1. Introduction ...................................................................................................1
2. Viral hepatitis in the countries of the World Health Organization
South-East Asia Region ...................................................................................2
2.1 Hepatitis A ........................................................................................................2
2.2 Hepatitis B ........................................................................................................2
2.3 Hepatitis C ........................................................................................................8
2.4 Hepatitis E .......................................................................................................11
2.5 The burden of viral hepatitis ............................................................................14
2.6 Issues that need to be addressed......................................................................16
2.7 References ......................................................................................................18
3. The vision, goal, mission, structure and implementation of the strategy .........30
3.1 Vision ..............................................................................................................30
3.2 Goal ................................................................................................................30
3.3 Mission ............................................................................................................30
3.4 Structure .........................................................................................................30
3.5 Implementation ...............................................................................................32
3.6 Reference ........................................................................................................32
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Regional strategy for the prevention and control of viral hepatitis
4. Strategic framework for policy, planning, advocacy and
resource mobilization ...................................................................................33
4.1 Policy and planning .........................................................................................34
4.2 Communication for advocacy ..........................................................................37
4.3 Resource mobilization .....................................................................................39
4.4 Reference ........................................................................................................40
5. Strategic framework for surveillance ..............................................................41
5.1 Challenges for viral hepatitis surveillance systems .............................................42
5.2 Model for viral hepatitis surveillance ................................................................44
5.3 Outbreak investigation and control ..................................................................48
5.4 Evidence-based interventions ..........................................................................48
5.5 Reference ........................................................................................................50
6. Strategic framework for research .......................................................................51
Reference .................................................................................................................55
7. Strategic framework for prevention and control ............................................56
7.1 Prevention of hepatitis A and E virus infection .....................................................57
7.2 Hepatitis A and E immunization ......................................................................58
7.3 Prevention of hepatitis B and C virus infection .................................................60
7.4 Hepatitis B immunization ................................................................................62
8. Strategic framework for education ................................................................64
8.1 Education programmes for general and at-risk populations ...............................65
8.2 Education programmes for health-care providers .............................................68
8.3. References ......................................................................................................73
9. Strategic framework for medical care and treatment .....................................75
9.1 Management of acute viral hepatitis ................................................................76
9.2 Medical care and treatment of chronic HBV and HCV infections .....................79
9.3 References ......................................................................................................82
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Regional strategy for the prevention and control of viral hepatitis
10. Summary of operational work required for implementation of the
Regional strategy for prevention and control of viral hepatitis by the
Member States and WHO ............................................................................84
10.1 Strategic framework for policy, planning, advocacy and
resource mobilization ......................................................................................84
10.2 Strategic framework for surveillance .................................................................86
10.3 Strategic framework for research ......................................................................87
10.4 Strategic framework for prevention and control ...............................................88
10.5 Strategic framework for education ...................................................................90
10.6 Strategic framework for medical care and treatment ........................................91
Annexes
1. Summary of viral hepatitis transmission risk activities, prevention
and treatment ...............................................................................................93
2. Surveillance of viral hepatitis .........................................................................96
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Abbreviations
AASLD American Association for Study of Liver Diseases
ALT alanine aminotransferase
APASL Asia Pacific Association for the Study of the Liver
ART antiretroviral therapy
DAA direct-acting antiviral agent
DTP diphtheria, tetanus, pertussis
EASL European Association for the Study of Liver
EIA enzyme immunoassay
EPI Expanded Programme on Immunization
FHF fulminant hepatic failure
HAV hepatitis A virus
HBcAg hepatitis B core antigen
HBeAg extracellular hepatitis B antigen
HBsAg hepatitis B surface antigen
HBV hepatitis B virus
HCC hepatocellular carcinoma
HCV hepatitis C virus
HDV hepatitis delta virus
HepB hepatitis B (vaccine)
HEV hepatitis E virus
Hib Haemophilus influenzae type b
IgM immunoglobulin M
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Regional strategy for the prevention and control of viral hepatitis
JIF joint reporting form
NGO nongovernmental organization
NIP national immunization programme
PATH Programme of Advancement Through Health and Education
PEP post-exposure prophylaxis
RC-VHLD referral centre for viral hepatitis laboratory diagnosis
RC-VHSPC referral centre for viral hepatitis surveillance, prevention and control
RT-PCR reverse transcriptase polymerase chain reaction
SGP Small Grants Programme
STI sexually transmitted infection
SVR sustained virological response
TB tuberculosis
UNICEF United Nations Children’s Fund
USA United States of America
WHO World Health Organization
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