WHO vows to reduce hepatitis infection rates in Vietnam

The World Health Organization (WHO) pledged to focus on nine countries in the Western Pacific Region including Cambodia, Kiribati, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Vanuatu and Vietnam facing significant challenges in meeting the 2012 target to reduce hepatitis B infection rates among children.

The 28th of July marks the first ever World Hepatitis Day. At the World Health Assembly in 2010, countries unanimously adopted a resolution calling for concerted action to address the viral hepatitis issue. July 28 was designated World Hepatitis Day, serving as an opportunity to promote specific actions towards preventing and controlling these viruses and the disease they cause. The theme of World Hepatitis Day in the Western Pacific Region is: "Knock down hepatitis B by 2012".

The Western Pacific Region has almost half the global cases of hepatitis B, while having only a third of the world's population. Countries in the region have committed to reducing hepatitis B infection rates in children to less than 2 percent by 2012 and to less than 1 percent as a future goal. Dr Shin Young-soo, WHO Regional Director for the Western Pacific, said reaching the target is crucial and do-able.
"Focused, concerted action is essential, especially in the countries in the Region that continue to suffer from high rates of mother-to-child transmission of hepatitis B virus," he said.

While most countries in the region have reduced hepatitis B infection rates in children to less than 2 percent, the nine are not yet there, mainly because of low vaccination coverage. In many of these countries, a major cause of low vaccination rates is the high number of births that occur at home without skilled birth attendants, making it difficult to deliver vaccines and other care services.

In Vietnam hepatitis B infection is present in 10 percent to 20 percent of the general population and is the cause of up to more than 80 percent of liver disease and cancers in the country. Co-infection rates amongst people living with HIV are also around 10 percent.

In 2003, Vietnam put in place a universal, infant hepatitis B vaccination program that increased coverage to 94 percent. Hepatitis B vaccination within 24 hours of birth reached more than 60 percent of newborns by 2005.

However, due to cases of unrelated death after immunization in 2006, many doctors in hospitals stopped birth dose vaccination and coverage dropped down to  around 20 percent. Vietnam's Ministry of Health has since made concerted efforts to increase the administration of birth dose vaccination and coverage is slowly recovering.

Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents. Treatment can be very expensive and access is limited in developing countries.Hepatitis C is also a contagious viral infection of the liver, but for which no vaccine has yet been developed. Hepatitis C infections are found worldwide with some 130-170 million people chronically infected.

Hepatitis C in Vietnam is a growing concern. People who inject drugs have especially high prevalence of hepatitis C infection, with up to 98.5 percent of them infected with the virus in Vietnam.
Reducing the risk of infection with hepatitis C requires avoiding unsafe injections and unscreened blood products. Improved infection control in health care settings and blood transfusion practice, and harm reduction programs for HIV prevention such as needle, syringe and condom distribution, are also critical to preventing transmission of hepatitis B and C.

Combination therapy with the medications interferon and ribaviron remains the mainstay of hepatitis C treatment, but they are costly and not yet widely available in Vietnam. However, in Vietnam a generic, lower-cost version of the drug, peginterferonalfa 2a, has recently been produced.

Furthermore, scientific advances and intense research are leading to the development of many new oral anti-viral drugs for hepatitis C infection. However, much still needs to be done to ensure that these advances can be accessible in limited resource settings.

By Uyen Phuong

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