Hepatitis B immunization programme: lessons learnt in Greece

doi:10.1016/S0264-410X(98)00293-X

Vaccine

Volume 16, Supplement 1, November 1998, Pages S45-S47

https://doi.org/10.1016/S0264-410X(98)00293-X Get rights and content

Abstract

Historically, Greece has had the highest burden of hepatitis B virus (HBV) infection in the European Union (EU). Heterosexual contact is the primary means of HBV transmission in Greece, accounting for approximately 30% of acute cases in adult males and 50% of acute cases in women of reproductive age [Kattamis C, Papevangelou G. Workshop Group: Greece. Vaccine 1995;13:S97–S98.]. In 1982, Greece implemented a hepatitis B prevention programme aimed at high-risk groups; unfortunately, this approach had little impact on disease incidence or prevalence. At the recommendation of the WHO and the World Health Assembly and after sustained lobbying by several scientific and medical associations in Greece, the Greek government decided to implement a national prevention programme for hepatitis B. The programme, in effect from early 1998, includes the screening of pregnant women, universal infant and adolescent immunization and immunization of high-risk groups.

Introduction

Hepatitis B virus (HBV) infection is considered a major public health problem world-wide. Several studies show that the incidence of acute hepatitis B and the prevalence of chronic hepatitis B and hepatocellular carcinoma are higher in Southern than in Northern European countries. In particular, Greece has the highest burden of HBV infections among the countries of the European Union (EU). Improvements in hygiene and living standards and the elimination of iatrogenic transmission over the last decades have resulted in a considerable decrease in HBV infections (Table 1). In certain regions and population groups, however, the prevalence of HBV infections remains very high.

HBV is responsible for the majority of acute viral hepatitis cases in adults in Greece. Heterosexual contact is the primary means of transmission, accounting for about 30% of acute viral hepatitis B cases in adult males and almost 50% of all acute viral hepatitis cases in women of reproductive age (Table 2) [1].

Section snippets

Initial response to problem

These data underscored the need for developing and implementing a national HB prevention programme in Greece. Extensive education campaigns were organised, blood donor screening programmes were instituted and measures to prevent iatrogenic transmission were successfully implemented.

Selective vaccination of high-risk groups was initiated in 1982. The high-risk approach, however, was not successful. Fear over the emerging HIV epidemic, difficulty in accessing most people in high-risk groups and

Greece adopts universal immunization

The National Committee on Vaccination and the National Committee for Viral Hepatitis for Greece advised the government to implement universal HB vaccination. The recommendation was denied because of financial constraints. Shortly thereafter, several scientific and medical associations (including the Greek Paediatric Association and the Society for the Study of the Liver) lobbied on the issue. In 1993, the government declared its intention to integrate universal vaccination against hepatitis B

References (1)

C. Kattamis et al.
Workshop Group: Greece
Vaccine
(1995)

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