Government - Global findings

One hundred and twenty-six Member States submitted the World Health Organization/World Hepatitis Alliance survey (“WHO/Alliance survey”) (Figure 1), a response rate of 64.9%. Respondents and non-respondents are listed by WHO region in Box 1.

Response levels by region are presented in Table 1, along with response levels by income group according to the World Bank classifi cation. The regional response rate varied from 26.1% for the African Region to 100% for the South-East Asia Region. Across income groups, the response rate ranged from 80.0% for high-income countries to 47.4% for low-income countries.

Box 1. Responses to the 2012 Global Hepatitis Survey from each WHO region

WHO African Region

Member States that submitted surveys:

Cameroon, Chad, Comoros, Côte d’Ivoire, Mali, Mauritania, Nigeria, Rwanda, Sierra Leone, South Africa, United Republic of Tanzania and Zimbabwe

Member States that did not submit surveys:

Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cape Verde, Central African Republic, Congo, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Niger, Sao Tome and Principe, Senegal, Seychelles, Swaziland, Togo, Uganda and Zambia

WHO Region of the Americas

Member States that submitted surveys:

Antigua and Barbuda, Argentina, Bahamas, Barbados, Brazil, Canada, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Suriname, United States of America and Uruguay

Member States that did not submit surveys:

Belize, Bolivia (Plurinational State of), Chile, Dominica, Haiti, Saint Vincent and the Grenadines, Trinidad and Tobago, and Venezuela (Bolivarian Republic of)

WHO Eastern Mediterranean Region

Member States that submitted surveys:

Afghanistan, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Kuwait, Lebanon, Oman, Pakistan, Qatar, Somalia, South Sudan, Sudan, Syrian Arab Republic and Yemen

Member States that did not submit surveys:

Libya, Morocco, Saudi Arabia, Tunisia and United Arab Emirates

WHO European Region

Member States that submitted surveys:

Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Hungary, Ireland, Israel, Italy, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Montenegro, Netherlands, Poland, Republic of Moldova, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Ukraine, United Kingdom of Great Britain and Northern Ireland, and Uzbekistan

Member States that did not submit surveys:

Bosnia and Herzegovina, Greece, Iceland, Kazakhstan, Monaco, Norway, Portugal, Romania and Turkmenistan

WHO South-East Asia Region

Member States that submitted surveys:

Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste

Member States that did not submit surveys:

no country

WHO Western Pacific Region

Member States that submitted surveys:

Australia, Brunei Darussalam, Cambodia, China, Japan, Kiribati, Lao People’s Democratic Republic, Malaysia, Mongolia, New Zealand, Papua New Guinea, Singapore, Solomon Islands, Tonga and Viet Nam

Member States that did not submit surveys:

Cook Islands, Fiji, Marshall Islands, Micronesia (Federated States of), Nauru, Niue, Palau, Philippines, Republic of Korea, Samoa, Tuvalu and Vanuatu

 

 

National coordination

Forty-seven responding Member States (37.3%) reported the existence of a written national strategy or plan that focuses exclusively or primarily on the prevention and control of viral hepatitis (Figure 2).

Eighteen of the 47 Member States with a strategy or plan reported that it focuses exclusively on viral hepatitis, and 20 reported that it addresses other diseases as well. Five countries reported that the strategy or plan addresses only hepatitis B and one reported that it addresses only hepatitis C. Three countries reported that the strategy or plan addresses both hepatitis B and hepatitis C.

The 47 Member States that reported the existence of a strategy or plan were asked about its specifi c components. Forty-six reported the inclusion of a component for vaccination. Fortythree reported the inclusion of a component for prevention of transmission in health-care settings, and the same number for general prevention and surveillance. Thirty-seven reported the inclusion of a component for treatment and care. Thirty-six reported the inclusion of a component for raising awareness. Thirty-fi ve reported the inclusion of a component for the prevention of transmission via injecting drug use.

Thirty-six responding Member States (28.6%) reported that they had a governmental unit or department responsible solely for viral hepatitis-related activities. Member States that did so were asked to indicate the number of staff members in the unit or department. Responses (N=30) ranged from 0.1 (New Zealand) to 250 (Brazil) (median, 5).

Member States were asked to report the number of people working full-time on hepatitis-related activities in all government agencies or bodies. Among the 47 Member States that provided data for this question, the number ranged from 0 to 213 (median, 2), with Armenia reporting the highest number.

Ninety-three responding Member States (73.8%) reported that they had a viral hepatitis prevention and control programme that included activities targeting specifi c populations. The populations most commonly targeted were health-care workers, including health-care waste handlers (86.0% of responding Member States within this subset) and people who inject drugs (54.8% of responding Member States within this subset). Fortyfour responding Member States (47.3%) reported the inclusion of activities targeting people living with HIV and 36 responding Member States (38.7%) reported the inclusion of activities targeting prisoners. Groups identifi ed less frequently included migrants, indigenous populations, low-income populations, those who are uninsured and those who are homeless.

Awareness-raising and partnerships

Forty-eight responding Member States (38.1%) reported that they had held events for World Hepatitis Day 2012 (28 July). Since January 2011, 36 responding Member States (28.6%) had funded some type of viral hepatitis public awareness campaign other than World Hepatitis Day (Annex A).

Sixty responding Member States (47.6%) reported that they collaborated with civil society groups within their countries to develop and implement the governmental viral hepatitis prevention and control programme.

Evidence-based policy and data for action

One hundred and four responding Member States (82.5%) reported that they have routine surveillance for viral hepatitis; details are given in Table 2.

One hundred and seven responding Member States (84.9%) indicated that their countries have standard case defi nitions for hepatitis infection and 100 (79.4%) indicated that their countries have a central registry for the reporting of deaths, including hepatitis deaths.

Fifty-seven Member States reported on the proportion of hepatitis cases and deaths registered as “undiff erentiated” or “unclassifi ed” hepatitis. The reported proportion ranged from 0% to 100% (median, 1.0%).a Additional survey fi ndings on surveillance are presented in Table 3.

a These figures represent data from 55 of the 57 Member States. Data from the Russian Federation and Mali are not included here because those Member States reported the information in a diff erent way. See the Russian Federation and Mali country fi ndings elsewhere in the report for information about undiff erentiated/ unclassifi ed hepatitis in those Member States.

Member States were asked how often hepatitis disease reports were published. Of the responding Member States, 40.5% reported that they publish hepatitis disease reports annually; 21.4%, monthly; and 12.7%, weekly. No hepatitis disease report is published by 23.8% of responding Member States.

Thirty-two responding Member States (25.4%) reported the existence of a national public health research agenda for viral hepatitis.

Forty-one responding Member States (32.5%) reported that viral hepatitis serosurveys are conducted regularly. Among this subset, 17.1% indicated that serosurveys take place at least once per year and, of the same subset, 43.9% reported that the most recent viral hepatitis serosurvey was carried out in either 2011 or 2012.

Prevention of transmission

Fifty-one responding Member States (40.5%) reported that they have a national hepatitis A vaccination policy.

Thirty responding Member States (23.8%) reported that they have established the goal of eliminating or reducing hepatitis B (Figure 3).

Member States were asked to report, for a given recent year, the percentage of newborn infants who had received the fi rst dose of hepatitis B vaccine within 24 hours of birth. Among the 86 Member States that provided this information, responses ranged from 0% to 100% (median, 58.0%). Member States were also asked to report, for a given recent year, the percentage of one-year-olds (ages 12–23 months) who had received three doses of hepatitis B vaccine. Among the 101 Member States that provided this information, responses ranged from 0% to 100% (median, 92.0%).

Ninety-six responding Member States (76.2%) reported the existence of a national policy that specifi cally targets mother-tochild transmission of hepatitis B; details are presented in Annex B. Of the Member States with such a policy, 65.6% indicated that one component of the policy calls for screening of all pregnant women for hepatitis B.

Eighty-eight responding Member States (69.8%) reported the existence of a specifi c national strategy and/or policy/ guidelines for preventing hepatitis B and hepatitis C infection in health-care settings.

Eighty responding Member States (63.5%) reported that healthcare workers are vaccinated against hepatitis B prior to starting work that might put them at risk of exposure to blood.

One hundred and nine responding Member States (86.5%) reported the existence of a national policy on injection safety in health-care settings. These Member States were asked which types of syringes the policy recommends for therapeutic injections. Single-use syringes are recommended in 77.1% of policies, and auto-disable syringes in 30.3% (Figure 4).

One hundred and ten responding Member States (87.3%) reported that single-use or auto-disable syringes, needles and cannulas are always available in all health-care facilities.

Member States were asked for offi cial estimates of the number and percentage of unnecessary injections administered annually in health-care settings (e.g. injections that are given when an equivalent oral medication is available). One hundred and thirteen Member States reported that the fi gures are not known and six did not reply. Among the seven responding Member States providing this information, responses ranged from 0% to 68.0% (median, 14.0%), with Denmark and Tonga reporting 0% and Mongolia reporting 68.0%.

Additional findings relating to the prevention of hepatitis transmission are presented in Table 4.

Screening, care and treatment

Member States were asked how health professionals in their countries obtain the skills and competencies required to eff ectively care for people with viral hepatitis. Responding Member States most frequently indicated that these are acquired in schools for health professionals (pre-service education, 77.0%). Additionally, on-the-job training was identifi ed in 73.0% of responses and postgraduate training in 61.6%.

Sixty-four responding Member States (50.8%) reported the existence of national clinical guidelines for the management of viral hepatitis (Figure 5). Thirty-fi ve of these 64 Member States indicated that the guidelines include recommendations for cases with HIV coinfection. Forty-four of 74 responding Member States indicated that there are national clinical guidelines for the management of HIV, which include recommendations for coinfection with viral hepatitis.

Fifty-nine responding Member States (46.8%) indicated that they have a national policy relating to screening and referral to care for hepatitis B. Forty-eight (38.1%) reported that they have such a policy for hepatitis C.

Regarding hepatitis B testing, 116 responding Member States (92.1%) indicated that people register by name for testing. One hundred and one members of that subset (87.1%) indicated that the names are kept confi dential. Fifty-two responding Member States (41.3%) reported that the hepatitis B test is free of charge for all individuals. Among the 70 other Member States that answered the question, 43 (61.4%) reported that the hepatitis B test is free of charge for members of specifi c groups. Groups identifi ed included blood donors, health-care workers, pregnant women, people living with HIV, patients on haemodialysis, prisoners and people who inject drugs. Sixty-one responding Member States (48.4%) reported that the hepatitis B test is compulsory for members of specifi c groups. Groups identifi ed included blood donors, health-care workers, pregnant women, people living with HIV, patients on haemodialysis and prisoners.

Regarding hepatitis C testing, 109 responding Member States (86.5%) indicated that people register by name for testing. Ninety-fi ve members of that subset (87.2%) indicated that the names are kept confi dential. Forty-eight responding Member States (38.1%) reported that the hepatitis C test is free of charge for all individuals. Among the 69 other Member States that answered the question, 39 (56.5%) reported that the hepatitis C test is free of charge for members of specifi c groups. Groups identifi ed included blood donors, health-care workers, pregnant women, people living with HIV, patients on haemodialysis, prisoners and people who inject drugs. Fifty-seven responding Member States (45.2%) reported that the hepatitis C test is compulsory for members of specifi c groups. Groups identifi ed included blood donors, health-care workers, pregnant women, people living with HIV, patients on haemodialysis and prisoners.

Seventy-nine responding Member States (62.7%) reported that publicly funded treatment is available for hepatitis B. Seventy-fi ve responding Member States (59.5%) reported that publicly funded treatment is available for hepatitis C. Fourteen responding Member States reported the amount spent on publicly funded treatment for hepatitis B and hepatitis C. Details can be found in the summaries of country fi ndings later in this report (see Argentina, Armenia, Bahrain, Croatia, Egypt, Lithuania, Myanmar, New Zealand, Pakistan, Poland, San Marino, Spain, Syrian Arab Republic and Turkey).

One hundred and three responding Member States (81.7%) reported that at least one available drug for treating for hepatitis B is on the national essential medicines list or is subsidized by the government (Table 5). The drugs most commonly reported were lamivudine, interferon alpha and pegylated interferon.

Eighty-three responding Member States (65.9%) reported that at least one available drug for treating for hepatitis C is on the national essential medicines list or is subsidized by the government. The drugs most commonly reported were ribavirin, pegylated interferon and interferon alpha.

World Health Organization assistance

Member States were asked to indicate areas in which they might want assistance from WHO for the prevention and control of viral hepatitis. Respondents most commonly selected the following: developing the national plan for viral hepatitis prevention and control (58.1%), estimating the national burden of viral hepatitis (54.8%) and developing education/training programmes for health professionals (54.0%) (Tables 6 and 7). Responses from individual Member States appear in Annex C.