1. Regional Workshop on Viral Hepatitis – WHO SEAR

2. Regional distribution of viral hepatitis deaths
Source: Global Burden of Disease

3. 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.

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

5. 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:

6. 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. >7%
2%-7%
<2%
Adopted and modified from CDC website:

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

9. 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.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

10. 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, 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

11. 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 , 14 pages, doi: /2014/481016

12. 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

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

14. 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

15. Over to Swarup