TURKISH VIRAL HEPATITIS PREVENTION and CONTROL PROGRAM TURKISH VIRAL HEPATITIS TURKISH 2018-2023 VIRAL HEPATITIS PREVENTION and CONTROL PROGRAM 2018-2023 ANKARA-2019 ANKARA-2019 TURKISH VIRAL HEPATITIS PREVENTION and CONTROL PROGRAM 2018-2023 ANKARA-2019 ISBN : 978-975-590-730-7 Ministry of Health Ed. No. : 1140 Publication : TGV Co., Ltd. Phone : +90 312 362 07 87 Fax : +90 312 362 59 48 Printing : Fersa Matbaacılık Co., Ltd. Phone : 0312 386 17 00 Interpreters : Deniz Cansen KAHRAMAN, Elif SERTESEN www.hsgm.saglik.gov.tr This publication has been prepared and published by Ministry of Health of Turkey, General Directorate of Public Health, Department of Communicable Diseases and Department of Vaccine Preventable Diseases. All rights of publication are reserved by Ministry of Health of Turkey, General Directorate of Public Health. No reference is allowed without giving full references. Not reproduced and republished. The references must be as follows: “Turkish Viral Hepatitis Prevention and Control Program (2018-2023)”, “Ministry of Health Ed. No, Ankara and Date of Publication”. Free of charge PUBLICATION BOARD Hasan IRMAK, M.D. Nazan YARDIM, M.D. Kanuni KEKLİK, M.D. Fehminaz TEMEL, M.D. PREAMBLE Viral hepatitis is an major public health problem that is encountered worldwide and has a negative impact on national economies. While the hepatitis C virus (HCV), along with chronic alcohol consumption, is the most frequent cause of chronic liver disease in Western society, the hepatitis B virus (HBV) and HCV infections are the most frequent causes of chronic liver disease in Turkey. Viral hepatitis may lead to acute and chronic hepatitis, cirrhosis, liver failure, and liver cancer (hepatocellular cancer, HCC), all of which can lead to morbidity and death. Approximately 25–40% of chronic HBV carriers may develop chronic hepatitis, cirrhosis, or HCC. Additionally, viral hepatitis leads to a decline in the productivity of patients and their relatives, along with the deterioration of their quality of life. One in three people worldwide has a history of HBV and over 250 million people are currently infected with HBV. It is estimated that 71 million people are infected with HCV and that 1.75 million new cases have developed globally since 2015. It is also estimated that more than 1 million people die from cirrhosis associated with viral hepatitis and HCC each year around the world. HBV and HCV infections are significant health problems in Turkey. One in three people over 18 years old has a history of HBV. It has been reported that HBV infection is the cause of 30–40% of cirrhotic cases and 40–50% of HCC, while HCV infection is responsible for 20–25% of cirrhotic cases and 25–30% of HCC. Between 2012 and 2016, more than half of liver transplantation recipients had experienced viral hepatitis-related liver disease prior to liver transplantation. Our ministry has taken massive steps toward the development of hepatitis vaccines for the treatment of viral hepatitis B over the last 25 years. With the wide application of the HBV vaccine, a considerable decline in the emergence of new HBV infection cases has been noted, with an associated decrease in HBV infection-linked acute and chronic liver diseases, cirrhosis or HCC development. Despite these major achievements, several measures remain to be implemented with a view to preventing and controlling viral hepatitis. Therefore, “The Turkish Viral Hepatitis Prevention and Control Program” has been conceived and designed as a multidisciplinary approach with the aim of further improving Turkey’s health policies targeting viral hepatitis. Within the scope of this program, several studies have been developed to raise awareness throughout Turkish society, particularly among those groups who are most at risk. Early diagnoses and appropriate guidance for patients with regard to treatment plans, in addition to the prevention of cirrhosis and liver cancer, with the intention of preventing disease transmission, are among the program’s priorities. For viral hepatitis to be recognized as a priority among the health problems that affect society, global efforts must be shaped into effective protection and control strategies in response to specific conditions at national and regional levels. This action plan, constituted with the aim of fighting the spread of viral hepatitis, is a national plan: each and every individual is responsible for actualization of this plan, along with academics and public and private organizations, particularly the Ministry of Health of Turkey. I would like to express my sincere gratitude to all partners who continue to support and contribute to this program. Fahrettin KOCA Minister of Health TABLE OF CONTENTS 1. INTRODUCTION ...................................................................................................................................................................................................................1 1.1. IMPORTANT FACTORS IN VIRAL HEPATITIS PREVENTION AND CONTROL.............................1 1.1.1 Awareness and Prevention .............................................................................................................................................................................1 1.1.2 High-Risk Populations ........................................................................................................................................................................................1 1.1.3 Surveillance and Screening ...........................................................................................................................................................................1 1.1.4 Access to Treatment and Appropriate Guidance to Patient ......................................................................................2 1.1.5 Multidisciplinary Approach ...........................................................................................................................................................................2 2. VIRAL HEPATITIS AND THE CURRENT SITUATION IN TURKEY ..................................................................2 2.1. HEPATITIS A VIRUS INFECTION.............................................................................................................................................................2 2.1.1 General Information ..............................................................................................................................................................................................2 2.1.2 High-Risk Populations for HAV Infection .....................................................................................................................................3 2.1.3 Tests for Diagnosis of Hepatitis A Infection ...............................................................................................................................4 2.1.4 Prevention of Hepatitis A Infection ......................................................................................................................................................4 2.2 HEPATITIS B VIRUS INFECTION .............................................................................................................................................................4 2.2.1 General Information ..............................................................................................................................................................................................4 2.2.2 High-Risk Populations for HBV Infection .....................................................................................................................................5 2.2.3 Tests for Diagnosis of Hepatitis B Infection ...............................................................................................................................6 2.2.4 Prevention of Hepatitis B Infection ......................................................................................................................................................6 2.2.5 Treating HBV Infection .....................................................................................................................................................................................7 2.2.6 Global Prevalence of HBV Infection .....................................................................................................................................................8 2.3 HEPATITIS C VIRUS INFECTION ..............................................................................................................................................................9 2.3.1 General Information ..............................................................................................................................................................................................9 2.3.2 High-Risk Populations for HCV Infection ................................................................................................................................. 10 2.3.3 Tests to Diagnose HCV Infection ........................................................................................................................................................ 10 2.3.4 Treating HCV Infection ................................................................................................................................................................................. 10 2.3.5 HCV Infection Prevalence and Incidence in the World .............................................................................................