On 3 September 2019, at Regional Committee 72nd of WHO South-East Region held in New Delhi, India, Dr Poonam Khetrapal Singh, Regional Director of WHO South-East Asia Region presented the award of public health achievement on Hepatitis B Control to Thailand’s Deputy Minister of Public Health, Mr Sathit Pitutecha. The ministry has been leading the country’s efforts to reduce the disease prevalence to less than one percent among five-year-old, significantly reduces chronic infections and cases of liver cancer and cirrhosis in adulthood.
Thailand has achieved the hepatitis B control target ahead of time. A key target to measure hepatitis B control in WHO South-East Asia region is reaching < 1% prevalence of hepatitis B surface antigen (HBsAg) among 5 years old children in 2020. Thailand has started introducing HepB vaccine nationwide in 1992 with the birth dose providing within 24 hours after birth and subsequent doses given at 4 and 6 months. Since 2008, four doses of HepB vaccine have been provided to children at birth, 2,4 and 6 months. Baby born with HBsAg positive mother receives one addition dose at age of 1 month.
Key pillars lead to Thailand’s success on HepB control include
- Investment in Research works/ Country own research capacity
- Strong technical body exists to guide immunization practice in the country
- Clear steps and guidelines for programmatic decision making in place
- Strong health service system (PHC/UHC) with quality health staff working on maternal and child and expanded programme of immunization including community health worker networks throughout the country
Globally, 257 million people are living with chronic hepatitis B virus (HBV) infections. Among them, 39 million (15% of the global number) are living in the World Health Organization (WHO) South-East Asia Region (SEAR) . They represent 2% of the total population of the Region. It is estimated that annually 296 000 people die of hepatitis B in the Region . Most are from liver cirrhosis and liver cancer, the consequences of chronic HBV infection.
Prevention of HBV infections relies on (i) three-dose hepatitis B vaccine for infants, (ii) prevention of mother-to-child transmission of HBV with birth-dose vaccine and other approaches in the near future, such as routine testing and treatment of pregnant women, (iii) blood, injection and surgical safety, and (iv) harm reduction for people who inject drugs. Prevention works and is documented as being cost–effective. There is a new generation of highly effective medicines available for treating chronic HBV infections and lifelong treatment can suppress HBV replication. Economic analysis in several countries indicates that population-based approaches to test and treat would also be cost–effective.
The risk of progression to chronic HBV infection is inversely related to the age at infection. Chronic HBV infection develops in 90% of infants infected before 1 year of age, in 25-50% of children infected at 1-5 years of age and in 5-10% of persons infected after 5 years of age (WHO position paper on hepatitis B vaccines 2017). Hepatitis B can be prevented by a safe and effective vaccine. Over 95% healthy infants develop protective antibody after the primary series of the vaccine and remain protected against the virus for at least 30 years . Since perinatal or early postnatal transmission is the most important source of chronic HBV infection, a birth dose of hepatitis B vaccine (HepB) should be given as soon as possible after birth, ideally within 24 hours.