Hepatitis

Pakistan has 12 million cases of hepatitis B and C (HBV/HCV) and is therefore highest country in the world to have such a high disease occurrence. Viral hepatitis B and C cause chronic liver disease and its complications and death and is a major concern for Pakistan.

Federal government recognized the importance of disease prevention and took steps towards disease prevention and strategizing its control. Following steps are being undertaken along with some achievements.

1. SOVALDI, the new oral drug for hepatitis C treatment has been registered in Pakistan on fast track and through special negotiations; its cost has been reduced by 99% as compared to that in USA. The drug is being given on special prescription to date but shall be available freely in a week.
2. Birth dose of hepatitis B vaccine has been sorted by making the Provincial program and the Federal EPI sit together and share the resources. The Provincial programs shall procure the vaccine and hand it over to Provincial EPI which shall store it in their cold rooms and give to new born children at health facility through their own EPI worker who also gives BCG and polio on day of delivery. There is no added cost and compliance report shall be sent to hepatitis program.
3. Infection control. Reuse of injections and improper sterilization of medical devices in health care is the major reason for hepatitis spread in Pakistan. These issues come under infection control, therefore WHO in collaboration with Pakistan Health Research Council (PHRC) has developed infection control guidelines, posters, small pocket book in Urdu for each health care provider and also supplied heavy duty WHO approved needle cutters and sharp containers to all BHUs, RHCs, DHQ and THQ of 25 high hepatitis districts of Pakistan. Materials have been sent, trainings done and now monitoring is being done.
4. Hepatitis B and C survey was supported by the federal ministry of health in 2006 to see the exact situation of the disease. The figures of this survey are used on the world maps by WHO, CDC and all partners while referring to hepatitis situation in the world. The survey is widely referred by researchers.
5. Technical Advisory Group (TAG) on hepatitis has been gazette notified by the federal government. It has experts from all Provinces and from WHO and CDC. This group of hepatitis experts’ advice the Federal and Provincial governments on issues related to hepatitis using scientific authentic references and not wishes.

Future strategies

1. Develop viral hepatitis strategy. TAG requested WHO and CDC USA to assist Pakistan in developing viral hepatitis strategy. Both partners agreed and the strategy is being developed in consultation with Provincial hepatitis experts and program.
2. Create awareness about disease. The disease can be tackled once behaviors are changed. Very aggressive media campaigns are being planned to create awareness about risk factors of disease and how to prevent them.
3. Hepatitis C treatment guidelines. Guidelines are being developed through technical support of WHO and CDC to ease diagnosis and treatment of disease.
4. Working together. All related programs like National blood transfusion authority, HIV AIDS, EPI, MNCH etc are being taken on board so that each program handles its component on hepatitis and reports back to program. This will reduce duplication.
5. Creation of Provincial infection control program. Provinces are being sensitized to have infection control program which shall cater for needs of all programs. All hospitals should have active infection control committees with regular monthly meetings with the hospital administration to check compliance to infection control by hospital staff. A cadre of infection control nurse needs to be created to make this functional.