The Viral Hepatitis Prevention Board, 10 years of support to the control and prevention

of viral hepatitis in Europe.

Alex VorstersViral Hepatitis Prevention Board Secretariat

Centre for the Evaluation of VaccinationWHO Collaborating Centre for Control and Prevention of

Viral Hepatitis

Unit of Epidemiology and Social MedicineUniversity of Antwerp, Belgium

Content

• Viral Hepatitis Prevention Board (VHPB)

• VHPB activities

• Hepatitis B control in Europe

• Hepatitis B vaccination: How to reach risk groups.

Viral Hepatitis Prevention Board

• The objective of VHPB is to contribute to the control and prevention of viral hepatitis– by drawing the attention to this important public health

problem

– by issuing prevention guidelines

– and by encouraging actions to improve control and prevention.

• VHPB focus audiences are, in first instance, opinion leaders, policymakers, and health care professionals.

Viral Hepatitis Prevention Board

• VHPB is established in 1992. First actions related to hepatitis B as an occupational risk.

• World Health Assembly sets in 1992 Hepatitis B Vaccination targets on the integration of hepatitis B vaccine into national childhood vaccination programmes.

• In 1993, VHPB started a second major initiative and focused on hepatitis B as a community health risk.

• The geographical focus was initially Western Europe, its actions are extended to include all 51 countries in the WHO/EURO

Viral Hepatitis Prevention Board

• members– CDC, CVP/PATH, WHO/HQ, WHO/EURO, MOH,

Universities

• network of experts

Viral Hepatitis Prevention Board

• Meetings– 2 - 3 meetings/year

• Viral Hepatitis Newsletter– 2 issues/year– mailing to appr. 5000 readers

• Web site• Scientific publications• Participation at Scientific Meetings

Web site www.vhpb.org

• Web site– Overview of the VHPB– Show all previous recommendations and consensus

statements– All Viral Hepatitis issues as of 1996 can be

downloaded– Presentations of VHPB meetings are one line since

2001

Meetings and Recommendations

• The VHPB has already covered a broad range of control and prevention strategies for all forms of hepatitis

– Surveillance

– Universal programs

– Injection safety and safe blood supply

– HBV mutants and variants

– Prevention and control of viral hepatitis in migrants and refugees

– Behavioural issues in hepatitis B vaccination

– How to reach risk groups

– Combined vaccines

– Economic evaluations

Support to the Introduction of hepatitis B vaccination in Europe

• Prevention and control of hepatitis B in Central and Eastern Europe and the Newly Independent States. ( Siofock, Hungary, 1996)

• Control of hepatitis B in Europe: Where are we in 1997 (Madrid Spain, Nov 1997) (Vaccine 16 (1998) S11-S16)

• Strengthening immunisation systems and introduction of hepatitis B vaccine in Central and Eastern Europe and the Newly Independent States. (St Petersburg, Russian Federation, 2001)

HBsAg prevalence in WHO/EURO region

Hep B immunization programmes in WHO/EURO region, 1993

Hep B immunization programmes in WHO/EURO region, 1996

Hep B immunization programmes in WHO/EURO region, 2002

Universal adolescent programmes in WHO/EURO region, 2002

Prenatal screening in WHO/EURO region, 2002

Reported immunization coverage rate WHO/EURO, 1990-2001

0

20

40

60

80

100

90 91 92 93 94 95 96 97 98 99 2000 2001Years

%

BCG OPV3/DTP3 MCV HepB3

WHO Regional Office for Europe

Hepatitis B vaccination: how to reach risk groups

• VHPB meeting March 2001– Pre-meeting document online (www.vhpb.org)

• Invited experts to cover the different risk groups

• Recommendations are available – Viral Hepatitis Issue Vol 10 N° 1– Meeting report in Vaccine 21 (2002)

Risk groups

• injecting drug users• health care workers and other workers with occupational risks for

hepatitis B• sex workers• persons who engage in unsafe sexual behaviour• household contacts and other social contacts of persons with HBV

infection• pregnant women and at-risk neonates• patients receiving blood or blood products, haemodialysis patients, and

transplant patients• prisoners and prison staff• travellers

Number of immigrants from high-risk regions in Denmark, 1991-2000

0102030405060708090

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Years

Num

ber

of im

mig

rant

s x

1000

AfricaAsia

Presented by Dr A-M Plesner, at VHPB meeting 2001 in Gent

Hepatitis B vaccination in sex workers

• Vaccination coverage for sex workers appears to be very low in many countries

• 82% of 168 first time contacts in the Gent sex worker outreach programme were not protected (Viral Hepatitis Issue 10.1, R. Mak)

– 18 (11%) naturally acquired HB infection

– 12 (7%) vaccinated before start of sex work

• Only one persons was vaccinated because of occupation as sex worker

VHPB plans for the future

• Public health challenges for controlling HCV infection. (Viral Hepatitis issue)

• Prevention of viral hepatitis in Italy: Lessons learnt and the way forward. (Viral Hepatitis issue)

• Overview of the VHPB recommendations (1995-2001) in a special Viral Hepatitis Issue.

• Vaccine Safety meeting (March 2003)

• Country meeting (Germany and Sweden, October 2003)

• Review the viral hepatitis prevention situation in Central and Eastern Europe and the Newly Independent States (2004)

www.vhpb.org

Thank you