Overview of HAV, HBV and HCV surveillance systems and results in Lithuania

IRMA Čaplinskienė

Head of HIV/AIDS/STI and Hepatitis Surveillance, Centre for 

Communicable Diseases and AIDS;National ECDC contact for hepatitis /STI/ 

HIV;  Member of the ECDC hepatitis B and C network;

Member of the International AIDS Society Scientific Board

Centre for Communicable Diseases and AIDS

SAULIUS Čaplinskas

Director, Centre for Communicable Diseases and AIDS;

Professor Mykolas Romerisuniversity, Vilnius

VIRAL HEPATITIS PREVENTION BOARD MEETINGRIGA, LATVIA, 19‐20 NOVEMBER 2015 

PREVENTION AND CONTROL OF VIRAL HEPATITIS IN THE BALTIC STATES: LESSONS LEARN AND THE WAY FORWARD

saulius@ulac.ltirma@ulac.lt

Incidence data – LR Legal Acts

• LR MoH, 24/12/2002, Order No. 673 „On approval ofprocedure for compulsive epidemiological registration,obligatory content of information about objects forepidemiological registration and mandatory informationsubmission“

• LR MoH 10/02/2005, Order No. V‐109 „On adoption of formsfor communicable diseases statistical reporting andaccounting“

• LR MoH 14/01/2008, Order No. V‐19 „On approval ofCommunicable Diseases and Their Agents NationalInformation System and data security provisions ofCommunicable Diseases and Their Agents NationalInformation System “

Reporting on communicable diseases to the National Information System of 

Communicable Diseases and their AgentsCase identification

(doctor)

PHcentres

Centre for Communicable Diseases and AIDS

Ministry of Health State Food and Veterinary Service

TESSy, WHO

Case data by primary diagnosis

Case based data

Case data

Communication by phone, mail, fax, email

Feedback

Source:

Communicable diseases (CD) cases and Incidence rate in Lithuania, 2007‐2014

721823

593341

757697

608226

745289

680240

851524

768157

22338,5

18552,2

23955,6

19637,4

24612,3

22767,5

28785,426195,8

0

5000

10000

15000

20000

25000

30000

35000

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

2007 2008 2009 2010 2011 2012 2013 2014

All CD

Rate per100 000population

Year

Source:

The structure of communicable diseases in Lithuania,  2014

Air borne diseases 95,76 %

Acute intestinal diseases 2,38%

TB 0,13%

Viral hepatitis 0,02%

Parasitoses1,49%

STI/HIV 0,13%

Other 0,08%

N= 762 588

Source:

1

2

3

4

5

6

Communicable Diseases in Lithuania in 

2014 

www.ulac.lt

13%

19%

25%

43%

Acute Viral Hepatitis in Lithuania

2014

2010

N=134

N=204

Nondiferentiated

7,8%

34,8%

20,1%

37,3%

HAVHBV

HCV

2010

N=204Source:

Incidence rate of acute viral hepatitis C and B(VHC and VHB) in Lithuania, 1990 – 2014

Source:Centre for Communicable Diseases and AIDS

22,43

18,09

12,59

16,6

18,89

14,2113,96

11,6612,69

10,14

13,40

10,75

7,9

5,05 5,424,24

3,272,60 2,81

1,83 2,30 1,98

0,77 1,180,90

0,880,99

2,48

2,72

3,02

3,00

3,24

3,17

3,44

3,7

2,81,98 2,05 1,90

1,42 1,34 1,50 1,32 1,42

1,34 2,00 1,16

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate per 100

 000

 pop

ulation

VHB VHCYears* ‐ no data available

*        *        *

Incidence rate of acute viral hepatitis A (VHA)in Lithuania, 1990 – 2014

103,81

54,84

97,23

68,24

138,3

148,08

99,85

78,92

38,7

7,2

40,9

7,60,8 0,3 0,8 2,23 3,03

0,71 0,63 0,51 0,52 0,56 3,78 2,160,58

0

20

40

60

80

100

120

140

160

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate per 100

 000

 pop

ulation

VHAYearsSource:

Incidence rate of acute VHA, VHB and VHC in Lithuania, 2005 – 2014

2,23,0

0,7 0,6 0,5 0,5 0,6

3,8

2,2

0,6

4,2

3,3

2,62,8

1,8

2,32,0

0,8

1,2 0,9

2,0 1,9 1,4 1,3

1,51,3 1,4

1,3 2,01,2

0

1

2

3

4

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate per

100 000 po

pulatio

n

Years

VHA VHB VHCSource:

Outbreak in Marijampole

Outbreak in Vilnius

HCV and HBV infection trendsRegistered cases in Lithuanian HC institutions in 2014

• 34 acute• in 2013 ‐ 59; 2012 ‐ 40;2011 ‐ 43; 2010 ‐ 41 

• 46 chronic • 0,11 ‐ acute VHC morbidity rate of (cases/10 000 pop.) 

• in 2013 ‐ 0,2;• 2012 ‐ 0,13;• 2011 ‐ 0,13

Source:

VHC cases  VHB cases • 26 acute

• in 2013 – 35; 2012 ‐ 23;2011 ‐ 60; 2010 – 73

• 3 chronic  • 0,089 ‐ acute VHBmorbidity rate of     (cases/10 000 pop.)• in 2013 ‐ 0,12;• 2012 ‐ 0,07;• 2011 ‐ 0,19

Distribution of acute HCV and HBV cases by age groups and gender in Lithuania, 2014

Source:www.ulac.lt

HAV incidence by age groupsin Lithuania, 2013‐2014

0

2.22.4

1.2

2

3.7

4.74.9

3.5

1.1

0.300 0 0 0 0

0.9

1.71.3

0.5 0.4 0.30.2

0

1

2

3

4

5

6

iki 1 m. 1‐3 m. 4‐6 m. 7‐9 m. 10‐14 m. 15‐17 m. 18‐24 m. 25‐34 m. 35‐44 m. 45‐54 m. 55‐64 m. 65 irvyresniAge group

Indicator p

er 100

,000

 pop

ulation

20132014

Source:

HAV infection place in Lithuania, 2013 – 2014 (patient survey data)

2013 2014

Annually repeating countries: Turkey, Egypt, PhilippinesSource:

Number of vaccinations with HA vaccine in Lithuania, 2013 ‐ 2015

5151

3547

2371

5080 

Source:

Children’s vaccination against VHB in Lithuania

• The newborns have been vaccinated against hepatitis B since 1998. 

• Since 2002 vaccination against hepatitis B of the 12 years‐olds, who’s vaccination was finished in 2010, has been included into children’s preventative vaccination schedule because generation of the 12 years‐olds, who (as newborns) have been vaccinated since 1998, grew up. 

Source:

Vaccination variationv (%), 2010 as compared to 2009

DTaP, IPV, Hib 2 months

BCG

Hep.B, newborns

Hep. B 12 year‐olds

Diphteria, tetanus 15‐16 years

Source:

Hepatitis B vaccination (newborns)

Year Number of persons Vaccinated. Non‐vaccinated Vaccination coverage/%2002 27267 27158 109 99.62003 27459 27294 165 99.42004 27211 26803 408 98.52005 26299 26036 263 992006 26570 26411 159 99.42007 26724 26457 267 992008 29407 29142 265 99.12009 29506 29211 295 992010 29461 28960 501 98.32011 29990 28707 1283 95.72012 29381 27396 1985 93.22013 25899 25311 588 97.72014 27028 26319 709 97.4

Non vaccinated

6 997

90

92

94

96

98

100

102

22000

23000

24000

25000

26000

27000

28000

29000

30000

31000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

%

Num

ber o

f persons

Year

Vaccinated Non‐vaccinated Vaccination coverage

Source:

Since 1998

Prevalence of HBV infection

• HBV markers are found in 30% of global population• 1 mill. new infections occur annually in Europe• In EU countries VHB incidence is decreasing• HBsAg prevalence varies from  0,1% to 7% in general population  in EU countries

HBsAg prevalence levels:<2% ‐ low, 2‐7% ‐moderate, >8% ‐ high

Source:

0.83.7

0.7

Source:European Centre for Disease Prevention and Control. Hepatitis B and C surveillance in Europe. 2012. Stockholm: ECDC; 2014.

Reported acute HBV per 100 000 population EU/EEA total 0.8

3.33.1

Source:European Centre for Disease Prevention and Control. Hepatitis B and C surveillance in Europe. 2012. Stockholm: ECDC; 2014.

Reported chronic HBV per 100 000 population 

EU/EEA total 8.6

Prevalence of HCV infection

• HCV markers are found in 3% of global population• 2 mill. new HCV infections worldwide each year• About 30 000 new hepatitis C cases are reported in EU and EEA countries each year.

• In EU countries VHC incidence is decreasing• Anti‐HCV prevalence varies from  0.4% to 3.5% in general population  in EU countries

Anti‐HCV prevalence levels:≤1% ‐ Low>1‐≤2% ‐Medium>2% ‐ High

Source:

Reported overal VHC per 

100 000 population 

EU/EEA total 7.8

Source:European Centre for Disease Prevention and Control. Hepatitis B and C surveillance in Europe. 2012. Stockholm: ECDC; 2014.

Hepatitis A, countries or areas at risk

Reported overal VHA per 

100 000 population 

EU/EEA total 2.6

Lithuania 3.76

Response to viral hepatitis in EU countries

Indicator categories : Prevention  Screening  Treatment availabilityNational strategy/NGO activities

Outcomes

Source: Health Consumer Powerhouse. Euro Hepatitis Index 2012 Reporthttp://www.healthpowerhouse.com/files/euro-hepatitis-index-2012/Report-Hepl-HCP-121104-2-w-Cover.pdf

Total score 1000

Source: Health Consumer Powerhouse. Euro Hepatitis Index 2012 Reporthttp://www.healthpowerhouse.com/files/euro-hepatitis-index-2012/Report-Hepl-HCP-121104-2-w-Cover.pdf