Increase Hepatitis B Screening and Vaccinations

Transcription

1 17 Increase Hepatitis B Screening and Vaccinations Situation Viral hepatitis is considered to be the most common contagious disease in Japan. Of the estimated three million patients and carriers of viral hepatitis B (HBV) and hepatitis C (HCV), 1.1 to 1.4 million people (approximately one percent of the Japanese population) are thought to be persistently infected with HBV. 1, 2 Since hepatitis has been linked to liver cancer, this type of cancer can be considered preventable, since HBV can be prevented by vaccine. HBV is transmitted via blood and bodily fluids. HBV remains infectious for at least one week even in a dry form after bleeding. 3 Many people have been infected without realizing it, since there have been various transmission routes, including mother-to-child transmission, mass vaccinations conducted with multiple usage of an injection syringe and a needle, and sexual transmission. The lack of obvious symptoms means that it is difficult for patients to notice that they have the disease, enabling the condition to advance. 70 to 80 percent of patients (approximately 1 million people) do not know that they are infected. 4 If a patient realizes that he or she is infected and receives appropriate treatment with regular liver functional testing, the patient s chances of developing liver cancer can be significantly reduced. The main reason for the low awareness is that people do not have comprehensive information about the risks and transmission routes, or which hospitals provide appropriate diagnosis and treatments. In 1986, a Mother-to-Child Transmission Prevention Program was started in Japan as an HBV infection control measure, whereby newborn babies of mothers carrying HBV were vaccinated. Following introduction of the program, the HBV carrier rate declined to 0.04 percent. However, the issue of infection due to other routes, including father-to-child transmission and child-to-child horizontal transmission at childcare centers remains. Further, in recent years, an acute viral inflammation via sexual transmission brought the HBV of genotype A into Japan from other countries. It is a new concern that acute infection with HBV genotype A, which has a higher rate of persistent infection than other genotypes, has been spreading in Japan. Furthermore, it has been reported that, when some patients with a history of HBV received chemotherapy and immunosuppressive therapy, the HBV was reactivated and at times caused severe hepatitis. 5 The World Health Organization (WHO) recommends that universal immunization with the hepatitis B vaccine should be conducted in all nations. While most countries have introduced universal vaccination programs for children (newborn babies and school children), vaccinations in Japan are given only to infants born to mothers infected with HBV. 6 Current Policy As stated earlier, in January 1986, the government of Japan started a vaccination program to prevent mother-to-infant infection with HBV in the case of infants whose mothers are infected with the virus. The program has been effective in preventing the vertical transmission of HBV from mothers to infants, but vaccination for the rest of the population is not included in the program. Therefore, horizontal HBV transmission remains an issue. Unless tested, it is very difficult for patients to recognize that they have HBV. In January 2015, the Immunizations and Vaccines Sub-council of the Health Science Council recommended introducing universal vaccination in infants. 6 However, the national budget for universal vaccination has not been secured yet and the timing of implementation is unclear. On November 19, 2009, the Hepatitis Basic Law Lengthening Healthy Lifespans to Boost Economic Growth 83

2 was enacted because hepatitis diseases are considered to be the most contagious diseases in Japan, and specific measures were considered necessary nationwide. According to this law, hepatitis control measures are a task of national importance in order to respect the human rights of infected patients. The law defines the basic principles of hepatitis control and clarifies the responsibilities of Japanese national and local governments in terms of ensuring comprehensive execution of measures for hepatitis prevention and early detection. The law also defines policies for the provision of economic support for treatments of infected patients. During the five years between 2002 and 2007, the Ministry of Health, Labour and Welfare (MHLW) encouraged Japanese people to be tested for both HBV and HCV on a regular basis (at the ages of 40, 45, 50, 55, 60, 65 and 70). However, data from 2005 revealed that the actual participation rate in HBV testing was only 24.9 percent (among the 4,848,053 people in the target age group, only 1,205,423 were tested). In 2007, MHLW data also showed that, during the same five-year period, out of 8,704,587 persons tested for hepatitis, 100,983 (1.16 percent) tested positive. Yet, it is estimated that only 30 percent of those who tested positive had a follow-up visit with physicians, although they were required, in principle, to undergo a second thorough examination. In principle, patients across Japan can receive screening free of charge at health centers and designated medical institutions. Blood tests can reveal whether a patient is infected with the hepatitis virus. Testing can be done quickly and the results are produced within a few weeks. In addition, in May 2011, the MHLW revised the basic guidelines for hepatitis testing to enable hepatitis screening tests to be included in employees annual medical checkups. In May 2011, the MHLW issued fundamental guidelines for the promotion of hepatitis virus screening that state all Japanese should receive the screening test at least once in a life and a system to provide broad screening services, and urge people to use the services, needs to be established. Free screening is still not available for employees who receive health insurance coverage through the health insurance associations of private employers. There is also concern about potential discrimination or bias against employees who are found to be infected with the hepatitis virus. Therefore, only a limited increase in the screening rate is expected even under current conditions. Recommendations As a preventive measure, the Japanese government should promptly introduce a universal hepatitis B vaccination program for all children based on the recommendation by the Health Science Council. Vaccination is an important means of infection control, and the risk of horizontal transmission remains high in Japan. In addition to those who have never been tested for the hepatitis virus, it is strongly recommended that the following persons should undergo an HBV test: Anyone who has had a health check at which tests of liver function revealed abnormal AST or ALT values, but who has not since been examined by a doctor or undergone a hepatitis test. Anyone born before 1985 (during that period there were no measures in place to prevent mother-to-child transmission). Anyone who has an HBV carrier in his or her family or whose family member died due to liver cancer caused by HBV. Measures should be implemented to further increase screening levels among the general public in Japan, which may result in a decrease in the prevalence of HBV in the country: 84 Lengthening Healthy Lifespans to Boost Economic Growth

3 Introduce effective hepatitis education programs across Japan for adults and students, based on public-private sector collaboration. Implement hepatitis screening tests as a standard item in employees annual health checkups. Currently, hepatitis screening tests are only recommended for employees medical checkups, but they should become mandatory requirements. Public funds should be provided so that there is no need for copayment or fees of individuals. National and local numeric goals should be set for hepatitis screening rates. Private companies, health insurance payers, and health advisors should cooperate to recommend appropriate treatment without discrimination if employees test positive for the hepatitis virus. References 1. Ministry of Health Labour and Welfare Ministry of Health Labour and Welfare. about.html 3. National Cancer Center Cancer Information Service Ministry of Health, Labour and Welfare Hepatitis B Vaccine Task Force. shingi/2r wdd-att/2r rr1.pdf. 5. Japan National Institute of Infectious Diseases Hepatitis V Vaccine Fact Sheet (July 7). shingi/2r bx23-att/2r bxqf.pdf and 6. Ministry of Health Labour and Welfare. Lengthening Healthy Lifespans to Boost Economic Growth 85

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