Maldives, Sri Lanka achieve Hepatitis B control

Maldives and Sri Lanka have achieved hepatitis B control, the World Health Organization announced today after an expert panel verified that the two countries have had consistently high coverage of hepatitis B vaccine doses in infants and a low prevalence of the deadly disease, corroborated through serological surveys conducted recently in both countries.

“I congratulate and commend Maldives and Sri Lanka on their achievement which once again demonstrates the earnest efforts being made by the health leaders and officials, health workers and the people of these countries towards health and well-being of communities,” said Dr Poonam Khetrapal Singh, Regional Director WHO South-East Asia.

The Expert Panel for Verification of Hepatitis B Control in WHO South-East Asia Region reviewed childhood immunization data from Maldives and Sri Lanka that showed consistent over 90% coverage with Hepatitis B vaccine doses provided during infancy for past many years. The experts also reviewed the findings of national surveys conducted among children in 2022-2023, in these countries.

“Based on the evidence presented to it, the Expert Panel concluded that the standards required for verification of Hepatitis B control have been met in both these countries and hence recommended that this important public health target has been achieved in Maldives and Sri Lanka”, said Dr Supamit Chunsuttiwat, chairperson of the Regional Expert Panel for verification of Hepatitis B control in South-East Asia.

The two countries join Bangladesh, Bhutan, Nepal and Thailand, who achieved the same feat in 2019.

Preventing Hepatitis B infection in infancy substantially reduces chronic infections and cases of liver cancer and cirrhosis in adulthood.

Hepatitis control continues to be an important public health initiative in the South-East Asia Region of WHO that comprises of 11 countries and is home to a quarter of the world’s population. The Region has an estimated 60 million people living with chronic hepatitis B and 218,000 dying every year of hepatitis B and C. Of the persons eligible for antiviral treatment only about 10% know their status and less than 5% of them are on treatment. 

In 2016, the South-East Asia Regional Immunization Technical Advisory Group endorsed a regional goal of hepatitis B control with a target of reducing hepatitis B prevalence to less than 1% among children aged at least 5 years. 

Hepatitis B vaccine, as a part of the pentavalent vaccine, has been included in the national childhood immunization schedule of all countries of the Region, with three doses of this vaccine provided to children during their first year of life. Eight countries of the Region also have a policy of providing a birth dose of Hepatitis B vaccine to the newborn babies. 

The Region made good progress in improving immunization coverage of the pentavalent vaccine until 2019. However, there was a decline in the coverage in several countries of the Region in 2020 and 2021 following the COVID-19 pandemic.  

Intensive efforts in countries have resulted in the revival of childhood immunization coverage to pre-pandemic levels in several countries and the WHO and UNICEF estimates for 2022 show that the overall coverage of 3rd dose of pentavalent vaccine has recovered to the pre-pandemic level of 91% in the Region, a sharp increase from 82% coverage level reported in 2021. 

Dr Khetrapal Singh said that countries also need to focus on improving the hepatitis B vaccine birth dose which continues to have a relatively slow uptake with an estimated coverage of only 58% in the Region in 2022. One of the key barriers for achieving high hepatitis B vaccine birth dose coverage remains the high proportion of home deliveries, that do not allow timely access of the Hepatitis B vaccine to these newborns, she said. 

Inequities in immunization service delivery, suboptimal awareness and/training of health staff at birthing facilities; particularly in terms of false contraindications and/or fear of adverse events following immunization also contribute to sub-optimal coverage of Hepatitis B vaccination coverage, the Regional Director said. 

The control of hepatitis B through immunization is a priority for our Region. Achieving the control goal is a critical step as we progress towards elimination of mother to child transmission of the hepatitis B virus, she said. 

WHO’s “triple elimination initiative” encourages countries to simultaneously commit to such elimination together with HIV and syphilis – further pushing the agenda for integrated service delivery.

"Hepatitis must be prevented and treated. In addition to vaccination, continued efforts are needed to scale up other preventive measures such as safe injection, safe blood and infection prevention and control,” the Regional Director said.