The World Health Organization recognized the achievements of the Republic of Moldova in the control of hepatitis B through immunization. In almost 30 years since the introduction of mandatory vaccination against hepatitis B, our country has managed to cover more than 90 percent of the population born during this period. Despite this success, there has been a continued decline in interest in immunization in recent years, and the vaccination rate has fallen by ten percent to below 90 percent.
In the letter accompanying the certificate of reaching the hepatitis B control target through immunoprophylaxis, it is mentioned that the Republic of Moldova has made a significant contribution to the elimination of viral hepatitis in Europe. The Regional Director for Europe of the World Health Organization, Hans Henri P. Kluge, states that thanks to vaccination, the prevalence of hepatitis B in the immunized groups in Moldova has decreased to 0.2 percent.
The Republic of Moldova received a similar certificate in 2000 after it succeeded in eliminating poliomyelitis through vaccination.
Decreased interest in vaccination increases the risk of hepatitis B infection
Veaceslav Guțu, head of the vaccine-preventable diseases section at the National Public Health Agency, says that this result was achieved following the successful implementation of national immunization programs. In the case of hepatitis B, the program provides for three doses of the vaccine, in the first 24 hours of life, at two and four months.
Immunization of the population against hepatitis B began in 1995 by vaccinating 20 percent of children up to one year old. In just five years, the Republic of Moldova managed to reach hepatitis B vaccine coverage of all children up to five years of age.
In the period 2000-2008 the vaccination rate was around 99 percent of children up to one year. After that, interest in the vaccine continued to decline and reached 96 percent coverage after 2010. In the last ten years we have witnessed a continuous downward trend, which has led to a ten percent reduction in the number of people vaccinated against hepatitis B. The statistics during the pandemic are even more alarming.
According to the National Bureau of Statistics, in the years 2020-2021 the number of children immunized against hepatitis B dropped below 90 percent and reached 89% of the number of children up to one year. This trend is registered for all vaccination categories that are part of the mandatory immunization program.
According to Veaceslav Guțu, behind the trend of decreasing interest in vaccination are several explanations, but also myths about the effects of vaccination.
“The first dose of hepatitis B vaccine is given within the first 24 hours after birth. Today with the first dose of vaccine administered in the first 24 hours after birth in maternity hospitals, we have over 95 percent coverage. Problems occur with the second and third doses. A lot of people forget to go to the vaccination office and here more involvement is needed from family doctors. Another explanation would be that in the first months of life, children enter certain acute phases of some diseases and parents postpone vaccination for a longer period, and this can lead to the abandonment of immunization. And last but not least, we are talking about certain myths related to vaccination and its effects that make some parents refuse to immunize their children”explains Veaceslav Guțu.
As interest in vaccination declines, the risk of group-wide infection increases. Veaceslav Guțu draws attention that the hepatitis B virus has not disappeared, it is present in society especially among adults who have not been immunized. In the Republic of Moldova, the incidence of chronic hepatitis is still at a very high level. It can cause fulminant hepatitis, especially in children.
The last case of acute hepatitis B in children was registered in 2021. It is about a two-year-old child who has not been vaccinated.
Hepatitis B remains a problem for unvaccinated groups
Beyond the recognition of the successes recorded in hepatitis B immunoprophylaxis, viral liver diseases remain a public health problem and a challenge not only for medicine, but also for society as a whole. In the last 24 years, the Republic of Moldova has adopted four national programs to combat viral hepatitis B, C and D. Today the authorities are working on formulating activities and objectives for the fifth programme. According to Silvia Stratulat, head of the hepatitis and HIV surveillance section within the ANSP, the latter will focus on the detection, surveillance and treatment of hepatitis cases.
“Starting from 2020, rapid diagnostic tests for hepatitis B and C were put into practice. In 2021, approximately 77 thousand people were tested for viral hepatitis C and another 70 thousand people for viral hepatitis B. The test allows obtaining the result in 30 minutes and is also available in health centers. After establishing the diagnosis, patients can start antiviral treatment, which has been free and accessible for six years. From 2016 until now, more than 25 thousand people have benefited, a quarter of whom are sick with hepatitis B”, said Silvia Stratulat.
Head of the hepatitis and HIV surveillance section within the ANSP stated that the authorities will expand the testing in the coming period in order to detect and diagnose new cases of hepatitis so that 90 percent of patients begin treatment and prevent complications caused by the virus. She also added that in the case of hepatitis B, the treatment does not lead to the disappearance of the virus, but it contributes essentially to the prevention of complications caused by the virus such as liver cirrhosis and liver cancer.
According to statistical data In the Republic of Moldova, there are over 40 thousand patients with chronic hepatitis B.
Each year, approximately five hundred new cases of chronic viral hepatitis B are detected in unvaccinated people.
The successful implementation of vaccination against viral hepatitis B has led to a significant decrease in acute viral hepatitis B. From 2004 to 2021, morbidity from acute viral hepatitis B has decreased approximately 50 times, from 10.6 to 0.27 cases per hundred thousand population. In comparison, viral hepatitis C morbidity saw a five-fold decrease. From 2.95 to 0.30 cases per hundred thousand population. One explanation would be that there is no hepatitis C vaccine.
To maintain the downward trend in the number of acute hepatitis cases, authorities consider controlling these infections and promoting vaccination among groups at increased risk of infection. Among them are people who come in contact with patients with viral hepatitis B, those who have several sexual partners, drug users, men who have sex with men, sex workers, migrants from areas with high prevalence of the virus and certain categories of chronic patients.
