Hepatitis B (acute)
Published: 06.10.05 Updated: 06.10.2005 11:25:05
Hans Blystad, Lars Blad, Johan Giesecke, Swedish Institute for Infectious Disease Control, Sweden, the Steering Group of the project Building a Network for Infections Disease Surveillance in the Baltic Sea Region
All countries in the region, except for Iceland and Poland, separately report acute cases of hepatitis B. Iceland and Poland reports all cases without distinguishing between acute cases and chronic carriers.
In the Nordic countries, Germany and the Baltic countries the incidence rates of hepatitis B fell dramatically in the early 1980s. This followed the introduction of targeted immunisation programmes among high-risk groups such as drug users and homosexual males. The introduction of HIV preventive measures such as disposable syringes in the medical services contributed to the fall in incidence rates in the eastern part of the region. However, in the 1990s, many of these countries re-experienced a surge in incidence rates caused mainly by outbreaks among non-immune drug users. This coincided with an increase in the number of young people injecting drugs. Since the early and mid-1990s, a growing number of intravenous drug users has resulted in very high incidence rates of hepatitis B in both Northwest Russia and the Baltic countries.
The overwhelming majority of hepatitis B cases in the region occur among intravenous drug users. Nosocomial infections mostly occur in the eastern part of the region. Being hospitalised is the strongest risk factor for acquiring hepatitis B in Poland. In Northwest Russia, children born to hepatitis B infected mothers are at greater risk to be infected and become chronic carriers than children from other parts of the region. Likewise, health care workers in the eastern part of the region have greater risk to contract hepatitis B than in the Nordic countries and Germany.
The most important prevention measure in the region is to reduce transmission of the hepatitis B virus among drug users. This will again lead to a reduction of sexual and mother-to-child transmission. Prevention among drug users relies on vaccination, information campaigns and implementation of general measures to reduce drug abuse, and introducing harm reduction by ensuring clean needles and syringes to drug users. Clean needles and syringes are available at pharmacies in the region. In addition, local health authorities in the region, except for Iceland and Sweden, have introduced extensive free needle programmes, needle exchange programmes or both. Hepatitis B vaccine is a part of the national immunisation programmes in Russia, the Baltic countries, Germany and Poland. Universal vaccination of newborns and/or teenagers is considered the best prophylactic strategy in endemic countries. None of the Nordic countries have so far included the vaccine in their national immunisation programmes. Instead, they have adopted a strategy of selective vaccination of high-risk groups such as drug users and men who have sex with men. In contrast to the rest of the region, few vaccination campaigns have been directed towards the drug communities in Northwest Russia. In the eastern part of the region hepatitis B vaccination of newborns and teenagers have not been fully implemented due to lack of funding. Health care workers are extensively vaccinated against hepatitis B in most parts of the region.