WHO European Region moving closer to control of hepatitis B

An estimated 15 million people in the Region are living with hepatitis B virus (HBV) infection and 56 000 die annually from the late effects of chronic infection, including liver cancer.

In 2017, 48 of the 53 countries in the Region conducted universal hepatitis B vaccination. Norway and the United Kingdom are the latest countries in the Region to add this vaccine to their routine immunization schedules. Norway began offering it in February 2017 for all babies born after November 2016, and the United Kingdom will start administering a hexavalent vaccine to children born after 1 August 2017.

With these 2 additional countries offering population-wide protection against the virus, the Region is one step closer to its goal of controlling hepatitis B infection, as established in the European Vaccine Action Plan 2015–2020. While this is commendable, much more needs to be done to eliminate the disease.

Safety and effectiveness of hepatitis B vaccination

Following a thorough review of available evidence, WHO concluded in a vaccine position paper on hepatitis B released in early July 2017 that vaccination programmes against hepatitis B are very safe and effective. Studies have shown a dramatic decrease in the number of cases of hepatitis-related liver cancer and deaths due to acute and chronic liver diseases among vaccinated people. Among health-care workers and other healthy adults, vaccination has also proven to be highly effective in preventing HBV infection.

Hepatitis B prevention and control

Eliminating the threat of hepatitis B requires a comprehensive approach that includes prevention of infections acquired immediately before and after birth and during childhood, as well as during adolescence and adulthood.

Besides vaccination, other effective prevention strategies against hepatitis B include:

• educating and empowering health workers and other at-risk groups, such as injecting drug users;
• promoting safe sex through the use of condoms;
• ensuring access to and availability of safe blood supplies and transfusion equipment; and
• strengthening infection prevention and control practices in all health facilities.

These interventions must be scaled up, and call for the involvement of everyone from health providers to community members to prevent the further spread of the disease.

Progress in Europe

In adopting the European Vaccine Action Plan in 2014, the Region committed to preparing a programme and action plan to control hepatitis B. This commitment was realized in the Action plan for the health sector response to viral hepatitis in the WHO European Region, adopted in 2016.

The vast majority of countries in the Region have successfully implemented universal childhood hepatitis B immunization programmes and achieved 90% or higher coverage with 3 doses of the vaccine. Three countries (Hungary, Slovenia and Switzerland) implement universal vaccination of older children and teenagers. Four countries (Denmark, Finland, Iceland and Sweden) with very low occurrence do not implement universal vaccination, relying instead on selective immunization of people who are at high risk for HBV infection, including health-care workers.

Priority actions

The European Action plan on viral hepatitis describes the priority actions that countries need to take in order to achieve hepatitis B control through vaccination. These include:

• improving the timeliness of the birth dose of hepatitis B vaccine;
• evaluating and improving hepatitis B screening during pregnancy and post-exposure prophylaxis of newborns;
• increasing and sustaining high coverage of 3 doses of hepatitis B vaccine; and
• conducting tests to measure and demonstrate the impact of hepatitis B vaccination.