Hepatitis B prevention in Indonesia Maisuri T. Chalid Hasanuddin University, Makassar
Prevalence of HBsAg in Indonesia: 3-9.4% # # NAD 12.8% RIAU 2.4% JAMBI 8.3% BANGKA BELITUNG 4.4% E. KALIMANTAN 6.4% GORONTALO 13.0% N. SULAWESI C. SULAWESI N. SUMATRA 11.7% W. SUMATRA 15.1% BENGKULU 19.3% S. SUMATRA 9.7% LAMPUNG 17.0% MOLUCCAS Indonesia has moved from high to intermediate endemicity of hepatitis B Parameter 2007 2013 1-14 >15 Total 1-14 >15 Total years years years years HBsAg (+) 8.3% 9.6% 9.4% 4.7% 6.6% 7.1% Anti-HBc (+) 10.9% 34.7% 32.8% 4.3% 31.8% 31.9% Anti-HBs (+) 32.2% 28.8% 30.6% 32.6% 35.5% 35.6% W. IRIAN JAYA PAPUA S.E. SULAWESI JAKARTA 5.9% W. JAVA C. JAVA JOGJA E. JAVA 8.2% 6.7% 2.5% 10.1% BALI 5.6% W. NUSA TENGGARA 5.5% S KALIMANTAN 6.6% S. SULAWESI 13.4% # Provisional data
HBsAg (+) dan HCV (+) PREVALENCE IN BLOOD DONORS IN BLOOD TRANSFUSION UNIT OF INDONESIA RED CROSS (2008-2013) 2,5 2 1,5 1 HBsAg HCV 0,5 0 2008 2009 2010 2011 2012 2013 Data resource: UTDP PMI 3
Distribution of HBsAg in pregnant women in Indonesia. Overall HBsAg prevalence among 69 891 pregnant women across 12 provinces in 2015 was 2 76%, which was lowest in West Sumatra (1 6%) and highest in West Papua (8 0%)
Prevalence of HBsAg among in Health Care Workers in 12 Provinces in Indonesia 2015 (2.56%). (Courtesy of the Subdirectorate of Hepatitis and Gastrointestinal infection, Directorate of Direct Communicable Diseases).
HB Vaccination in Indonesia WHO Pilot Project in Lombok Island. Indonesia was selected as the first model of HB integrated to EPI (1987-1991) Expanded to 4 Provinces: NTB, Bali, Jogja & East Java Added: 3 provinces (Papua, NTT & East Timor) Added: 6 Provinces (Central Java, West Java, DKI, Lampung, West Sumatra & West Borneo) National Program 1987 1991-1992 1992-1993 1996-1997 1997 2000 Birth dose started
Proportion National Health Survey 2013 9,0% 8,0% 7,0% 6,0% Distribution of HBsAg (+) according to Age Group 8,3% 6,9% 6,8% 6,7% 6,8% 7,1% 7,6% 8,1% 7,2% # HBsAg (+): 7.1% (N = 40,791) covering 33 provinces) 7,1% 6,8% 7,1% 5,0% 5,7% 4,0% 4,2% 4,2% 3,0% 2,0% 1,0% 0,0% 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-59 >60 indone 1-14 15 Years sia tahun positif 4,2% 7,1% 6,8% 4,2% 5,7% 6,7% 6,8% 6,9% 8,3% 7,6% 8,1% 7,2% 7,1% 6,8% 7,1% New cases continue to occur in under-five children # Provisional data
Coverage of birth-dose hepatitis B immunization in Indonesia (2000-2014)# 100 90 80 70 60 50 40 30 20 10 0 WHO Target 85,8 81,1 85,6 80,5 75,6 68,4 60,3 54,2 42,8 41,2 40 31,4 11,5 3 1,8 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Coverage of hepatitis B immunization in Indonesia (2000-2014)# (HB3 completed) Realisasi DPT/HB3 combination #Courtesy of Directorate General of CDC, Ministry of Health, Republic of Indonesia
Proportion National Health Survey 2013 60,0% Anti-HBs (+): Result of Immunization Anti-HBs (+): Resolved from infection 50,0% 53,5% National infant immunization 1997 52,5% 40,0% 30,0% 20,0% 32,5% 27,7% 21,2% 19,9% 24,3% 28,4% 32,7% 37,2% 40,6% 45,5% 35,6% 30,5% 36,5% 10,0% 0,0% 1-4 5-9 10-14 15-19 20-24 25-29 Years 30-34 35-39 40-44 45-49 50-59 >60 Indone sia 1-14 tahun 15 positif anti HBs 53,5% 32,5% 27,7% 21,2% 19,9% 24,3% 28,4% 32,7% 37,2% 40,6% 45,5% 52,5% 35,6% 30,5% 36,5% positif anti HBc 4,3% 5,8% 7,4% 11,1% 18,1% 24,0% 29,4% 33,9% 38,6% 38,7% 45,1% 50,1% 31,9% 6,7% 35,4%
Universal of hepatitis B in your country Hepatitis B Yes/no Target (who is vaccinate + age (if relevant)) Since/period Universal YES 0-9 months 1997 Risk groups NO HCW -
Hepatitis B prevention- Immunization (combined/mono valent) Available hepatitis vaccines Disease NAME (producer) Target group Monovalent HepB Uniject HB (prefiled syringe) for HB birth dose BIOFARMA Combined HepB Pentavalen (DTP-Hib-HepB) Pentabio vaccine neonates babies 1-9, 18 mo Issues with hepatitis/ Combined (what are the problems in your country with use of combined Hep B ) Coverage various through out the country Drop out ( people assumption that thimerosal as a preservative is thought to cause autism) Post-immunization side effect=> parental concerns Procurement for new vaccines=> High price ; limited national and local budget Opportunities (how do you think this issues can be solved) Availability Socialization (education) broad explanation through social media Special policy and funding
Indonesia Extra information on birth dose(bd) Yes/no Since/period Coverage Birth dose in universal program Issues with BD in your country More than 40% of births occur at home(2014), assisted by midwives (68%) and traditional birth attendance (TBA)(12.68%) Unfriendly geographical situation and inadequate access to health facilities in some remote areas Not recognized as health priority, lack of awareness among populations at risk Indonesian culture (some ethnics): before 40 days babies can t accept injections Lack of IEC material for HB Birth dose Successes with BD in your country Integration into: mother and child health programs (MCH) - as part of package of maternal and newborn care community health service posts (Pos Yandu): a unique community initiated activity assisted by local health care providers to carry out basic health services (MCH, family planning, nutrition, immunization, hygiene and sanitation) Involvements of professional associations (pediatricians, hepatologist, obstetricians), private hospitals, family and practicing doctors Involvement of traditional and religious leaders Development of simplified recording and reporting system on pregnancies and births