Dr. Irma Asuncion Director National Center for Disease Prevention and Control Department of Health

1. A PROGRESS REPORT ON THE
CONTROL OF HEPATITIS B
IN THE PHILIPPINES

2. Disease Burden
 >12% prevalence of chronic Hep B infection

3. HB Control Targets
 Hepatitis B is a priority
•
 In 2005, countries in the Western Pacific Region including
the Philippines aimed to:
 Milestone : Reduce the prevalence of chronic HBV
infection to <2% among children aged ≥5 years by 2012
 Goal: Reduce the prevalence to ≤ 1% among children ≥5
years by 2017

4. Strategies to Achieve the Goal
• High coverage of 3 doses of hepatitis B vaccine (HepB3),
with a birth dose given within 24 hours of birth
• Measuring the prevalence of chronic HBV infection by
conducting representative seroprevalence surveys;
• Verifying achievement of a reduced prevalence of chronic
HBV infection by submitting country-level data to be
reviewed by a regional verification panel.

5. Strategy 1: Hepatitis B vaccination
• ≥65% timely birth dose coverage defined as within 24H
after birth
• ≥ 85% three (3) dose of Hepatitis B vaccine coverage

6. Immunization Schedule for Infants
AGE
Antigen
At birth 1 ½ mo
BCG
3 ½ mo
9mo
12mo
√
HepB
2 ½ mo
√
DPT-HepB-Hib
√
√
√
OPV
√
√
√
Rota
√
√
Measles
MMR
√
√

8. THE MANDATE….

9. WHAT HAS BEEN DONE?
…..Hepatitis B immunization
in the PhilHealth Newborn
Package…
Time Band:
90minutes to 6hrs
Intervention:
Inject HepB and BCG

10. Strategy 2: Measure Impact-1
• Field assessment of the hepatitis b birth dose practices in health
facilities in 2011
• Done in 8/17 regions in the country
• 142 health facilities were assessed (health centers , lying-in
clinics, public & private hospitals with deliveries)

12. Strategy 2: Measure Impact-2
• National Hepatitis B Seroprevalence Study in 2013
• 1st Hepatitis B seroprevalence survey conducted in the Philippines
among children
• Objectives
• Primary: To determine the seroprevalence of HBsAg among 5-6
year old children.
• Secondary: To evaluate the HepB vaccination effectiveness by
reviewing the HepB vaccination coverage including timing of the
first dose along with the seroprevalence of HBsAg in the sampled
population

13. Strategy 2: Measure Impact-2
• National Hepatitis B Seroprevalence Study in 2013
• Sample population were children born between
January 1, 2007- December 31, 2008
• 3000 children aged 5-6 years old
•
• RESULT will be available SOON……

14. Strategy 3: Verification of Reduced
Prevalence of chronic Hep B Infection
• Country notify WHO readiness for the verification process
• Submits evidences that the prevalence of chronic hepatitis
reduced.

15. HBV prevalence among blood donors and
OFWCs* (2002-2004)
HBsAg
Number
Tested
Number
positive
%
Blood Donors
Male
59,740
2,551
4.27
5,214
153
2.93
64,954
2,704
4.16
Male
30,484
1,374
4.51
Female
49,186
1,952
3.97
All
79,670
3,326
4.17
Female
All
OFWs
* Yanase, Gill, et. al

16. HBsAg positivity rates among clients of Laboratories
Participating in EQAS of NRL – SACCL
(2010-2012)
Year
2012
2011
2010
HBV Total
Tested
HBV(+)
%+
#lab
2,206,310 99,184
4.49
1019
1,936,046 97,814
5.05
789
1,712,645 90,052
5.25
429
Census of Natioanl Reference Lab – STD AIDS Cooperative Laboratory

17. What has been done. . .
Guidelines for the Implementation of a Workplace
Policy and Program on Hepatitis B (DOLE)
All establishments are encouraged to provide mandatory HepB
vaccination to employees
– Required for healthcare workers and high-risk individuals
• Individuals with HepB should not be declared unfit to work without
medical evaluation, nor terminated on the basis of HepB status
• confidentiality, referral system in the workplace
• Screening for HepB as pre-requisite for employment shall not be
mandatory
• Those who contract HepB in the course of their duty are entitled of
Health benefits under SSS and Employees Compensation Benefits
under PD 626
• IEC on hepatitis
https://dl.dropbox.com/u/84112124/Department%2520Advisory%2520No.
%252005%2520%28Corrected%2520Copy%29%5B1%5D.pdf

18. What has been done. . .
• Policy on Post Exposure Management
(PEM) for HIV, Hepatitis B & C in
Healthcare Settings (DOH) – Technical
Guide
• All hospitals shall include Hepatitis B and C into existing HIV
awareness campaign by HACT or ICC
• New entrant health care personnel in clinical and ancillary
departments shall be required to undergo mandatory Hep B
vaccination
• All cases of accidental exposures should be reported to ICC
for a decision to commence PEP

19. • Policy on Post Exposure Management (PEM) for
HIV, Hepatitis B & C in Healthcare Settings

20. •
What has been done. . .
• Guidelines and packages which help assist service
providers and managers including safety, quality
and availability of blood are available
• Infection control guideline -prevention of hepa B
and other diseases in the health care setting
• Persons with active chronic Hep B and HIV can
now benefit new treatment with anti-retrovirals

21. Action Points

22. Action Points

23. Action Points
• Increase awareness and knowledge on hepatitis
including that of health care workers integrated
with other health promotion activities
• Enhance Planning and working with partners

24. •
Challenges
• surveillance systems for HepB – basis for
evidence-based policy actions
• People Who Inject Drugs - horizontal and vertical
transmission
• Many chronically infected individuals are unaware
of their Hep B status
• Behavior change

30. Support Healthy Lifestyle Programs
•Enforce restrictions on smoking in public places and near schools based on the Tobacco
Regulations Act
•Enforce restrictions on selling tobacco products based on the Tobacco Regulations Act
• Grant access to lands that the community can use as pocket farms to grow fruits and
vegetables
• Hold community feeding programs to teach children the value of nutritious food
• Hold lectures for mothers to teach them how to prepare healthy yet inexpensive food
• Provide courts and facilities that can serve as venue for physical activities
• Host sports fests that will foster healthy competition and sportsmanship
• Hold a community exercise program to in partnership with local gym or fitness center
instructors?
• Enforce restrictions on selling alcohol to minors

31. Thank you for your attention. . .