Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person. 240 million people are chronically infected with hepatitis B every year globally. More than 686 000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer 1. Hepatitis B is an important occupational hazard for health workers.

1. HEPATITIS B INFECTION
Presented by
Dr.Rakhshinda Ambreen
MSPH batch II
AIPH,JSMU

2. CONTENT
• Background
• Pakistan’s scenario
• Risk factors
• Prevalence in Pakistan
• Prevention and control

3. BACKGROUND
• Hepatitis B is a viral infection that attacks the liver and can cause
both acute and chronic disease.
• The virus is transmitted through contact with the blood or other
body fluids of an infected person.
• 240 million people are chronically infected with hepatitis B
every year globally.
• More than 686 000 people die every year due to complications of
hepatitis B, including cirrhosis and liver cancer 1.
• Hepatitis B is an important occupational hazard for health
workers.

4. PAKISTAN’S SCENARIO
*Qureshi H, et al. (2010). ***CDC. (Oct 2011).2
• Chronic HBV prevalence:
2.5% (4 million)*
Highest rate of therapeutic
injections in the world: up to 13
injections/person/year

5. HEPATITIS B PREVALENCE IN PAKISTAN
1.1M 2.4M

6. RISK FACTORS FOR ACUTE HEPATITIS, PAKISTAN,
2010-2011
• Distribution of risk factors 6 weeks prior to infection
Source: CDC. (Oct 2011). 3

7. RISK FACTORS

8. HIGH RISK GROUPS
•Surgeons
•Dental surgeons
•Nurses
•Lab technicians
•Blood bank workers
•Homosexuals
•Sex workers
•IV drug abusers
•Infants of HBV carrier
mothers

9. Blocking the channel of transmission:
Sterilization, avoid sharing of toothbrush/syringes/razors, screening
of blood, safe sex practice
Protection of susceptible individuals:
Active immunization and passive immunization
Prevention of mother to child transmission:
Protection and immunization
PREVENTION AND CONTROL

10. HEPATITIS B IMMUNIZATION SCHEDULE
Regular dosage Rapid schedule chronic
hemodialysis
patients
Post prophylaxis Special dosage
schedule
Adults: 3 doses
each
1 ml at 0,1,6
months IM
Below 10 years-
neonates: 0.5ml
EPI 6 wks,10 wks.,
14 wks.
Booster dose after
5 years
For high risk
individuals:
surgeons, dentists,
lab tech. 0,1,2 with
boosters at 12
months followed
by a booster after
every 8 years
4 doses each of 40
mcg at interval of
0,1,2,6 followed by
booster dose once
in 5 years
HBIG dose 0.05 to
0.07 ml/kg
bodyweight. 2
doses are given
with an interval of
4 weeks. It
protects for about
3 months. This
should be given
with in 24 hours of
exposure.
Active and passive
immunization
(HBs Ag +HB Ig)
New born of
carrier mothers
are given vaccine
with in 12 hours of
birth but not later
than 48 hours

12. GOVERNMENT’S EFFORTS
Hepatitis control program Pakistan started in 2005
Objectives :
• control of transmission
• Mortality
• infected waste
• free immunization
• capacity building and training of healthcare professionals

13. ACHIEVEMENTS
• Infection control training in 25 high risk districts (WHO &
PMRC)
• Medicine have been distributed among 38 sentinel sites.
• Computers purchased and distributed to develop data bank.
• Health promotion activities.

14. ACHIEVEMENTS
• 38 Sentinel sites for diagnosis , screening and treatment has
been established
• A network of PCR Labs has been established to facilitate PCR
testing.

15. Any questions??
THANK YOU!

16. REFERENCES
1. K.Suriya, water born disease, viral hepatitis; Community
medicine with recent advances;2nd edition.pg. 369-373
2. Qureshi H, et al. (2010). East Mediterr Health J;16 Suppl:S15-
S23. **Homie Razavi, APASL STC, Karachi, October 2014.
***CDC. (Oct 2011). Establishment of a Viral Hepatitis
Surveillance System – Pakistan, 2009-2011. MMWR, 60(40),
1385-1390.
3. Source: CDC. (Oct 2011). Establishment of a Viral Hepatitis
Surveillance System – Pakistan, 2009-2011. MMWR, 60(40),
1385-90.