Iran as a member of the World Health Organization, the global health agency, has pledged to eliminate hepatitis B and C as public health challenges by 2030. The Health Ministry is implementing schemes to achieve this goal.
“Unprotected sex and risky sexual behavior among jail inmates and addicts in rehabilitation centers have necessitated making them the main target groups of the programs,” said Dr. Mohammad Mahdi Guya, head of the ministry’s Center for Infectious Diseases, at a press conference on the occasion of World Hepatitis Day (July 28).
Fortunately the groups that are at high risk of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, including prisoners and intravenous drug users, are easily accessible, he said, according to Fararu News website
So far, 35,000 prisoners have been vaccinated against hepatitis B and the ministry plans to extend coverage to all prisoners by the end of the current fiscal year in March 2017.
All prisoners are compulsorily screened for the diseases, and free treatment is provided by the ministry.
A group that is not easily accessible but at great risk of developing HBV, are sex workers. The establishment of specific health centers for this stratum would be an effective measure to keep the disease in check. However there are many constraints in this regard, Guya noted.
“Based on official figures, currently, HBV infection rate is less than 1% among people younger than 28 years of age. The figure is less than 0.5% for individuals below the age of 22.”
The prevalence rate of hepatitis B was 5% at one time, but has fallen to less than 2% in all provinces except Sistan-Baluchistan and Golestan where it is a little above 2%.
The decline can be attributed to implementation of the national immunization program that started in 1993 for infants and high-risk age groups.
HBV Prevention Programs
Since then, annually almost all infants (90%) have been given hepatitis B vaccine.
In 2006, the ministry decided to vaccinate, over a four-year period, all those who were born between 1989 and 1992, as they had entered the reproductive years and were at risk of getting the disease if they were sexually active.
In order to reach the goals set by 2030, the Health Ministry should vaccinate all unvaccinated people under the age 40 by the end of 2026. Vaccination of all municipal workers, people working in beauty salons, healthcare workers and infants for HBV is on the agenda.
While official figures say 1.4 million people are infected with the hepatitis B virus, unofficial sources claim that 7% of Iranians carry the virus.
The infected people may or may not show symptoms of the infection since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves, Guya said.
Infection in Drug Addicts
While HBV can be transmitted via unprotected sex, contact with infected blood, sharing needles, syringes, razors, or toothbrushes with infected person, and mother-to-child during childbirth, HCV is rarely transmitted through unprotected sex.
The main routes of hepatitis C transmission are primarily by needle-sharing with infected people during IV drug use and also mother-to-child in childbirth.
There are between 180,000 to 250,000 people infected with HCV in the country and most of them are injecting drug users. About 96% of infected prisoners are men.
Since 1996, all donated blood is screened for HCV in the country and therefore the risk of acquiring HCV infection from transfused blood has been reduced to almost zero.
At a recent seminar on ‘Eliminating Hepatitis C by 2030’ held at Iran University of Medical Sciences in Tehran, Deputy Health Minister for Research Reza Malekzadeh announced that a domestically produced antiviral biosimilar Interferon (IFN)-based medicine has been introduced under the name ‘Sovodak’ for treatment of HCV. Given the relatively young age of the HCV infected population in the country, timely intervention is necessary to reverse the rising trend.
HCV infection is a growing global health issue. Those living with chronic HCV infection are at risk of developing advanced liver diseases such as cirrhosis and hepatocellular carcinoma (HCC).
Setting up harm reduction centers (where homeless men and women can visit to get tested for HIV/AIDS, hepatitis B and C, and receive necessary education as well as means of prevention), methadone therapy for de-addiction which lacks the risks of transmitting the virus and drop-in centers (DICs) for street addicts are among other measures taken to reduce hepatitis infection rate.
Global Data
According to the WHO, in 2013, viral hepatitis was a leading cause of death worldwide (1.46 million deaths, a toll higher than that from HIV, tuberculosis or malaria, and on the increase since 1990). More than 90% of this burden is due to the sequelae of infections with HBV and HCV.
So far, HBV infection has affected 400 million people worldwide.
Prevention can reduce the rate of new infections, but the number of those already infected would remain high for a generation. In the absence of additional efforts, 19 million hepatitis-related deaths are anticipated from 2015 to 2030. Treatment now can prevent deaths in the short- and medium term.
Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the exchange of body fluids and blood.
Globally, between 130 and 150 million people have chronic hepatitis C infection.
