Regional Workshop on Viral Hepatitis – WHO SEAR

Regional distribution of viral hepatitis deaths Source: Global Burden of Disease http://vizhub.healthdata.org/gbd-compare/#settings=f53a9677cb8e4ff596bc37f980aa0276322ecc39

Estimated number of hepatitis B, hepatitis C and HIV infections in SEARO Population data from World Health Statistics 2011, WHO. b Data from various sources (government report, scientific publications). c Data from HIV/AIDS in South-East Asia Region progress report 2010, WHO South-East Asia Regional Office.

Disease Burden Hepatitis A: 400 000 cases with 800 deaths annually; Hepatitis B*: 1 380 000 cases with 300 000 deaths annually; Hepatitis C*: 500 000 cases with 120 000 deaths annually; Hepatitis E: 12 million cases with 42 000 deaths and 1800 stillbirths annually; Acute hepatitis of unknown etiology: 200 000 cases with 5000 deaths. * Includes cirrhosis and liver cancer.

HCV distribution across the world 130–170 million people world wide are infected with HCV China 30 M N. Korea 0.2 M Europe 18 M* S. Korea 0.8 M Americas 14 M* Middle East 16 M* Africa 28 M* Japan 3 M India 18 M Prevalence of HCV >10% 5–10% 2–5% Indonesia 9 M 1–2% <1% No data Australia 0.2 M * Estimated number of chronically infected individuals (2010) Lavanchy D. Clin Microbiol Infect 2011; 17:107–115; CDC: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-c.htm.

Prevalence of HCV in Asia-Pacific countries Prevalence = % anti-HCV (2010); HCC = hepatocellular carcinoma. Lavanchy D. Clin Microbiol Infect 2011; 17:107–115; Lee MH, et al. Gut 2011; 60:688–694;

>7% 2%-7% <2% Adopted and modified from CDC website: http://www.cdc.gov/Features/dsHepatitisAwareness/

HBsAg seroprevalence and the number of people living with chronic HBV in SEARO countries *A Schweitzer et al, Lancet, 386 (2015), pp. 1546–1555

Seroprevalence of Hepatitis B - Blood Donors Ante-natal Mothers IDUs MSM PLHIV Hemodialysis Bangladesh 1.64%1 0.40%2 6.20% Bhutan 5.4% India 1.18%4 2.9%5 33.20%6 5.78%7 1.52%8 Maldives 0.8%9 6% , 1%9 Myanmar 0.5%10 9.1%11 Nepal 0.82%12 0.5%13 3.5%14 3.2%15 Sri Lanka 0.2%16 Thailand 2.63%17 3.4% 18 13.9% 19 8.7%20 10. http://www.lib.okayama-u.ac.jp/www/acta/pdf/64_5_317.pdf 11.http://www.who.int/substance_abuse/publications/atlas_report/profiles/myanmar.pdf 12. http://www.ncbi.nlm.nih.gov/pubmed/18653982 13. http://www.tropicalgastro.com/articles/33/2/chronic-hepatitis-b-in-nepal.html 14. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134455 15. http://www.nepjol.info/index.php/NJE/article/view/12831 16. http://www.health.com.kh/author_attachment/hiv_viral_hepatitis_coinfection_experience_from_sri_lanka.pdf 17. http://www.tm.mahidol.ac.th/seameo/2011-42-3/15-4961.pdf 18. http://www.idthai.org/Publication/pdf/Vol22-3/Ch3-V22-3.pdf 19. http://www.hindawi.com/journals/heprt/2014/296958/ 20. http://www.ncbi.nlm.nih.gov/pubmed/15825712 http://banglajol.info/index.php/JDMC/article/viewFile/21528/14784 http://www.ncbi.nlm.nih.gov/pubmed/22299410 http://www.ncbi.nlm.nih.gov/pubmed/11262767 http://www.icmr.nic.in/ijmr/2015/september/0911.pdf http://www.jidc.org/index.php/journal/article/viewFile/24240041/943 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129325/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818601/ http://www.hindawi.com/journals/heprt/2013/860514/ http://www.searo.who.int/maldives/documents/BBS_Maldives_2008.pdf?ua=1

Seroprevalence of Hepatitis C - General Population Blood Donors IDUs PLHIV Bangladesh 1.3%1 0.09%2 24.8%3 Indonesia 0.8%1 2.1%4 71%5 34.10%7 India 0.21%8 53.7%9 3.02%10 Myanmar 1.7%1 0.95%11 5.3%12 Nepal 0.6%13 0.47%14 49.9%15 42%16 Sri Lanka 0.6%17 1.06%18 Thailand 0.94%19 0.51%20 86.0%21 7.7%22 11. Myo-Khin K et al 2010 12. Zhou et al.2013 13. Shrestha SM et al1998 14. Shrestha AC et al 2009 15. Kinkel H-T et al 2015 16. Barnawal SP et al 2013 17. Gunasekera, H et al 2002 18. Senevirathna D et al 2011 19. Wasitthankasem R et al 2016 20. Chimparlee N et al 2011 21. Jaroon Jittiwutikarn et al 2006 22. Phuangchoei P et al. 2015 Gower et al., 2014 Rudra S et al 2010 Shirin T et al. 2000 Sulaiman HA et al. 1995 Injecting Drug User data, 1999-2001 fr om Yayasan Harapan Perata Hati Kita and Pelita Foundation …….. Anggorowati, N et al 2012 Raina S et al 2015 Ray Saraswati L et al 2015 Ponamgi S et al 2009

Prevalence of anti-HEV among the general population of South Asia Country Number of samples Anti-HHEV rate (%) Children Adults Overall India (north) 2070 24–29 — India (Andaman) 814 13–40 16–77 15–73 India (Chennai) 185 5.3–17 India (south) 2279 0.6–8.9 9.2–36 9.1–23 Bangladesh 1134 23 Thailand 513 Indonesia 1115 0.5–20 José-Manuel Echevarría, “Light and Darkness: Prevalence of Hepatitis E Virus Infection among the General Population,” Scientifica, vol. 2014, Article ID 481016, 14 pages, 2014. doi:10.1155/2014/481016

Issues and Challenges Political commitment and advocacy – two countries with committed full time MOH staff for HEP Paucity of robust representative data Lack of Public health approach Centralized care and treatment – limited access Lack of awareness Cost of care Low coverage with birth dose in some countries Resources

Issues and Challenges (Contd.) Safety in health care settings Safe Injection Safe blood

Opportunities Interest and political commitment Awareness National plans and strategies – INO, TLS, (MMR), (DPRK) (BAN) (THA) Maximizing opportunities – HIV-HEP C (India); Surveillance (Bhutan); Treatment (NEP) Cost effectiveness THA Awareness Price Reductions GHSS, UHC and SDG

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