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 Hepatitis B virus (HBV) infection is a major public
  health problem in the Middle East.
 The majority of the countries in the region have an
  intermediate or high endemicity of HBV infection.
PREVALENCE OF HBV CARRIER STATUS

    Classification of countries based on HBsAg +ve carriers:



     ≤2%              •Low Endemicity


                      •Intermediate
2% - 5%                Endemicity


  ≥5%                 •High Endemicity
STATUS IN
                                            HEPATITIS B CARRIER RATES AND VACCINATION
                                                      MIDDLE EAST COUNTRIES
           HBsAg       HB
                              Vaccination
Country    carrier vaccine     Coverage
               %     in EPI
Bahrain   0.9 – 1.25 YES          89
  Iran         1      YES         81
Kuwait        1.5     YES         94
 Israel        1      YES         92
STATUS IN
                                             HEPATITIS B CARRIER RATES AND VACCINATION
                                                       MIDDLE EAST COUNTRIES
COUNTRY     HBsAg HB vaccine   Vaccination
           carrier % in EPI     Coverage

Cyprus     2-2.5   Yes         68
Iraq       4-5     Yes         59
Libya      2-6     Yes         -
Emirates   2-5     Yes         90
HEPATITIS
                                                      STATUS IN
 COUNTRY        HBsAg      HB vaccine   Vaccination
               carrier %     in EPI      Coverage




                                                                              B CARRIER RATES AND VACCINATION
   Egypt         3-11         Yes           82




                                                      MIDDLE EAST COUNTRIES
  Jordan         3-10         Yes           90
   Oman          2-10         Yes           99
 Palestine        5-6         Yes            -
   Sudan         16-20        No             -
Saudi Arabia     7-17         Yes           95


  Tunisia         6-7         Yes            -
  Yemen         12-18.5       Yes           42
MODE OF TRANSMISSION

 HBV can be transmitted at perinatal, childhood
  or adult ages.
 The main modes of transmission are mother-to-
  child, child-to-child, sexual and parenteral.
MODE OF TRANSMISSION
            IN THE MIDDLE EAST

 the majority of infections occur through childhood and
  perinatal transmission.
 There is limited information on sexual transmission in
  Middle East societies.
 Parenteral transmission in health institutions should
  be limited due to routine screening of blood products.
 The number of intravenous drug users in the Middle
  East remains low compared to other regions, but there
  is little information on unsafe injection practices.
MOTHER-TO-CHILD TRANSMISSION BY HBEAG
                        Number       % of




                                              STATUS IN
              Number
Status tested          of positive positive
                tested
                         babies     babies
  HBsAg-
                 120




                                                         HBSAG-POSITIVE MOTHERS
  positive                 25         21
               (100%)
  mothers
  HBeAg-
  positive    16 (13%)     15         94
  mothers
  HBeAg-
  negative 104 (87%)       10         10
  mothers
FACTORS ASSOCIATED WITH HBV INFECTION



  Family size,
 Age at infection

 Socioeconomic status,

 Educational status and

 History of previous blood transfusion, surgery or
  contact with a jaundiced person.
PREVENTION OF HBV INFECTION

 Active immunization (universal and targeted),
 Routine blood screening for HBsAg and
  ensuring of safe injection practices.
 Passive Immunization using hepatitis B
  immunoglobulin (HBIG) is not common in the
  Middle East because the majority of chronic
  carriers result from childhood transmission, the
  cost is high and there is a large proportion of
  home deliveries in many Middle East countries.
 Safe sex is not officially promoted in most
  countries of the region for cultural reasons.
Country      Year

Saudi Arabia   1989




                                           INTRODUCING ACTIVE IMMUNIZATION
   Qatar
  Kuwait       1990




                      IN THE MIDDLE EAST
  Oman
 Bahrain       1991
   Iraq
  Syria
 Emirates

   Egypt       1992
 Palestine     1993
  Jordan       1995
   Tunis
  Yemen        1998

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Epidemiology of hepatitis b

  • 1.
  • 2.  Hepatitis B virus (HBV) infection is a major public health problem in the Middle East.  The majority of the countries in the region have an intermediate or high endemicity of HBV infection.
  • 3. PREVALENCE OF HBV CARRIER STATUS  Classification of countries based on HBsAg +ve carriers: ≤2% •Low Endemicity •Intermediate 2% - 5% Endemicity ≥5% •High Endemicity
  • 4. STATUS IN HEPATITIS B CARRIER RATES AND VACCINATION MIDDLE EAST COUNTRIES HBsAg HB Vaccination Country carrier vaccine Coverage % in EPI Bahrain 0.9 – 1.25 YES 89 Iran 1 YES 81 Kuwait 1.5 YES 94 Israel 1 YES 92
  • 5. STATUS IN HEPATITIS B CARRIER RATES AND VACCINATION MIDDLE EAST COUNTRIES COUNTRY HBsAg HB vaccine Vaccination carrier % in EPI Coverage Cyprus 2-2.5 Yes 68 Iraq 4-5 Yes 59 Libya 2-6 Yes - Emirates 2-5 Yes 90
  • 6. HEPATITIS STATUS IN COUNTRY HBsAg HB vaccine Vaccination carrier % in EPI Coverage B CARRIER RATES AND VACCINATION Egypt 3-11 Yes 82 MIDDLE EAST COUNTRIES Jordan 3-10 Yes 90 Oman 2-10 Yes 99 Palestine 5-6 Yes - Sudan 16-20 No - Saudi Arabia 7-17 Yes 95 Tunisia 6-7 Yes - Yemen 12-18.5 Yes 42
  • 7. MODE OF TRANSMISSION  HBV can be transmitted at perinatal, childhood or adult ages.  The main modes of transmission are mother-to- child, child-to-child, sexual and parenteral.
  • 8. MODE OF TRANSMISSION IN THE MIDDLE EAST  the majority of infections occur through childhood and perinatal transmission.  There is limited information on sexual transmission in Middle East societies.  Parenteral transmission in health institutions should be limited due to routine screening of blood products.  The number of intravenous drug users in the Middle East remains low compared to other regions, but there is little information on unsafe injection practices.
  • 9. MOTHER-TO-CHILD TRANSMISSION BY HBEAG Number % of STATUS IN Number Status tested of positive positive tested babies babies HBsAg- 120 HBSAG-POSITIVE MOTHERS positive 25 21 (100%) mothers HBeAg- positive 16 (13%) 15 94 mothers HBeAg- negative 104 (87%) 10 10 mothers
  • 10. FACTORS ASSOCIATED WITH HBV INFECTION  Family size,  Age at infection  Socioeconomic status,  Educational status and  History of previous blood transfusion, surgery or contact with a jaundiced person.
  • 11. PREVENTION OF HBV INFECTION  Active immunization (universal and targeted),  Routine blood screening for HBsAg and ensuring of safe injection practices.  Passive Immunization using hepatitis B immunoglobulin (HBIG) is not common in the Middle East because the majority of chronic carriers result from childhood transmission, the cost is high and there is a large proportion of home deliveries in many Middle East countries.  Safe sex is not officially promoted in most countries of the region for cultural reasons.
  • 12. Country Year Saudi Arabia 1989 INTRODUCING ACTIVE IMMUNIZATION Qatar Kuwait 1990 IN THE MIDDLE EAST Oman Bahrain 1991 Iraq Syria Emirates Egypt 1992 Palestine 1993 Jordan 1995 Tunis Yemen 1998