The world has been overwhelmed with COVID-19 pandemic in the past three years which has led to the publication of hundreds to thousands of articles, podcast, talk, lectures of COVID-19 related educational materials. Even though COVID-19 has not gone completely, and probably never will- the threat of COVID -19 is much less now, thanks to the immunization.
Unfortunately, other sicknesses haven’t stopped threatening just because the world is in its biggest pandemic of the century. It is also no secret that most tropical diseases are neglected diseases that mainly affect resource-limited countries like Myanmar. Those diseases cause devastating health and socioeconomic consequences to many people affected directly or indirectly. Hepatitis B virus infection is one of those which are endemic globally but remains a high burden in developing countries as a neglected tropical disease due to poor access to effective prevention and treatment measures.
Five percent of the world population has chronic hepatitis B, but the highest HBV prevalence is in Asia, Africa and part of the Middle East. According to WHO report from 2019, it was estimated that 18 million of people are living with hepatitis B virus infection (HBV) in the South-East Asia Region1 with the overall prevalence of HBV among children below 5 reported at 1.1%.2 The country with the highest estimated prevalence (3.8%) is Myanmar which is also estimated to have the highest rate of perinatal chronic infections in the region, at 16 per 1000 live births.3
For many people, hepatitis B is a short-term illness but for others, it can become a long-term, chronic infection that can lead to serious health issues like cirrhosis or liver cancer. Risk for chronic infection is related to age at infection: about 90% of infants with hepatitis B will go on to develop chronic infection, whereas only 2%–6% of people who get hepatitis B as adults become chronically infected.4 Myanmar being a country with the highest perinatal infection rate, it is not unexpected that it also has a significant liver cancer incidence (11/100,000), more than double the regional incidence in Southeast Asia (5.1/100,000).5 The best way to prevent those devastating consequence of hepatitis B is prevention, i.e. to get immunized against hepatitis B.
On the bright side, since 2012, hepatitis B vaccine has been in the mandatory child hood vaccination program which is one of the rare health services that can be available free of charge.6 However, a recent study on vaccine equity in Myanmar showed that populations of low socioeconomic status still has poor vaccine access.7 Even if the people are able to effectively utilize the childhood vaccination program, 3.8% (about 2 millions) of the population are infected with hepatitis B who required medical attention and management. They may not recognize the infection since many of them may not have any symptoms for years.
Among many challenges, part of the issue is affordability and accessibility while another concern is lack of health education. Although it takes effort from several levels which is not an easy task for the time being, I believe it is still going to be beneficial if the initiation of health education, offering testing, vaccination, and referring for treatment begins with our workforce of general practitioners who already have an excellent rapport with their patients.
Sincerely,
Tinzar Basein, MD
Infectious Disease Specialist
(IM1 Class 95-2003 Alumni)
References
- WHO Global hepatitis report, 2017.
- Goldstein ST, Zhou F, Hadler SC, Bell BP, Mast EE, Margolis HS. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Int J Epidemiol. 2005;34(6):1329–39. https://doi.org/10. 1093/ije/dyi206
- Childs L, Roesel S, Tohme RA. Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992–2015. Vaccine. 2018;36(1):6–14. https://doi.org/10.1016/j.vaccine.2017.11.027.
- https://www.cdc.gov/hepatitis/hbv/index.htm
- Cancers 2022, 14, 4473. https://doi.org/10.3390/cancers14184473
- Anderson et al. Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011–2016: results from a national survey BMC Health Services Research (2022) 22:516.
- Win ZM, Traill T, Kyaw ZL, et al. Equity assessment of childhood immunisation at national and subnational levels in Myanmar: a benefit incidence analysis. BMJ Global Health 2022;7:e007800. doi:10.1136/ bmjgh-2021-007800
