Epidemiology and Control Programs for HBV Infection.

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Epidemiology and Control Programs for HBV
Infection.

• Yousef Qari, MD, FRCP(C), ABIM
• Gastoenterologist
• King Abdulaziz University Hospital

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Epidemiology of Hep B Worldwide

• 2 billion people are infected with this virus
• 350 million Chronic HBV infection.
• 10th leading cause of death in the world

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Route of Transmission of HepB

• High endemicity
• Perinatal (vertical)
• Acquired in preschool years.
• Low endemicity
• Early adult life
• Intravenous drug use
• Unprotected sexual activities

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Worled Prevalence of Hep B
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Based on pooled data from surveys in Saudi Arabia
up to 1988
PROVINCE NUMBER OF MALES TESTED POSITIVE NUMBER OF FEMALES TESTED POSITIVE
Central 2155 6.9 4494 4.1
Southwest 1593 13.8 5642 3.9
Eastern 7838 11 462 8.2
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The prevalence of HBsAg and other markers of HBV
among residents of Jizan
Ayoola AE Saudi Med J.  2003 24(9)991-5
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HBV and HCV prevalence among dialysis patients
in Bahrain and Saudi Arabia
Qadi AA Am J Infect Control.  2004
32(8)493-5 (ISSN 0196-6553)
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A chronology of hepatitis Bprogrammes in Saudi
Arabia

• PROGRAMME TYPE YEAR OF IMPLEMENTATION
• Mandatory
• All newborns (0-1 year)
  1989
• Children at school entry (6-7 years)
  1990
• Voluntary
• Pre-school children (1-5 years)
  1990 / 1991
• Health personnel (adults)
  1990
• Others
  1989

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HBV prevalence had declined among Saudi children
eight years after the integration of the
hepatitis B vaccine into the national EPI.
Al-Faleh FZ et al, B. J Infect 1992
24197-206. Al-Faleh FZ et al.. J Infect 1999
38167-170.
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The decline of hepatitis B viral infection in
South-Western Saudi Arabia.
Ayoola AE Saudi Med J.  2003 24(9)991-5 
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Prevalences of HBsAg and anti-HCV among Saudi
donors before and after the adoption of the
revised AABB blood donation guidelines.
Clinical and Diagnostic Laboratory Immunology,
November 2003, p. 1159-1160, Vol. 10, No. 6
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Prevalence of HBV, HCV among blood donors in a
teaching hospital in the Central region of Saudi
Arabia.
24000 patients
El-Hazmi MMSaudi Med J.  2004 25(1)26-33 
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There has also been a significant decline of HBV
markers among unvaccinated Saudi adults

• Declining HBsAg prevalence in asymptomatic adults
  in Gizan ()

1985 1992 1997
Males 19.9 9.4 5.8
Females 9.3 6.1 4.2
Total 13.9 7.7 5.1
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Hepatocellular carcinoma in Saudi Arabia Role of
hepatitis B infection.
1.9 per 1000 (2.3 in men, 1.2 in women).
N118
N118
Ayoola EA J Gastroenterol Hepatol.  2004
19(6)665-9 
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Natural History of Hep B
HBV Infection
15-40
HBV
Chronic Hepatitis Cirrhosis HCC
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• The real challenge
• To decrease the incidence of HCC in our
  population by decreasing the prevalence of
  Hepatitis B.

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Conclusion

• According to the EPI programmes, all Saudi
  citizens under the age of 26 years should have
  been vaccinated by the year 2008.
• The low prevalence of HBsAg in children, provides
  evidence for the effectiveness and efficacy of
  the integration of hepatitis B vaccination into
  the extended program of immunization in KSA.

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Conclusion

• The significant decline of HBV markers among
  unvaccinated Saudi adults indicated an indirect
  effect of other factors like health education and
  socio-economic progress
• The ongoing program of HBV vaccination may
  significantly decrease the prevalence of
  HBV-associated HCC in Saudi Arabia

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Thank you