Hepatitis B Catch-Up Vaccination Program To Protect At-Risk Healthcare Workers, Medical Students And Adolescents

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In 2009 the Minister of Labour, Health, and Social Affairs of Georgia, Alexander Kvitashvili, and the head of the National Center for Disease Control, Dr. Paata Imnadze,  requested the assistance of the Rostropovich-Vishnevskaya Foundation (RVF) in establishing a hepatitis B catch-up vaccination program for at-risk healthcare workers, medical students, and adolescents. The program built on the efforts supported by the RVF to prevent the transmission of hepatitis B from carrier mothers to their newborns, carried out in 2006 – 2012, in which all pregnant women in Georgia were screened for hepatitis B carriage.

Epidemiologic data emerging from the screening program have unmasked an unexpectedly high burden of hepatitis B among women of childbearing age, indicative of intermediate endemicity as defined by the World Health Organization (WHO). In areas of intermediate endemicity the lifetime risk of HBV infection is 20-60%, and infections occur in all age groups. It was this compelling statistic that induced the Georgian government to request the assistance of the RVF to begin a hepatitis B catch-up vaccination program to protect segments of society that were at high risk of infection. Hepatitis B is the most common infectious cause of severe liver disease. It can lead to live failure, cirrhosis and liver cancer. It is entirely preventable through vaccination.

Under the program all 13-year-olds in the capital Tbilisi and all medical students and at-risk healthcare workers throughout Georgia were eligible for vaccination against hepatitis B, which required a total of 3 doses given over a six-month period. The program was kicked off by seminars for chief medical doctors and key opinion leaders in vaccinology, followed by training sessions for medical workers, who in turn  educated parents of adolescents about the importance of vaccination against hepatitis B All vaccinations were administered on a voluntary basis.

In 2001-2002 the government of Georgia incorporated hepatitis B vaccination into the routine childhood vaccination schedule. All newborns receive the hepatitis B vaccine within the first day of life and complete the series of three doses by about 6 months of age. When this program started there was no defined epidemiology of the burden of hepatitis B in society. Beginning in December 2005, at the request of the government of Georgia, the RVF formulated a program to screen the entire cohort of pregnant women to indentify carriers of hepatitis B surface antigen (HBsAg) and to enhance the protective efficacy of the extant neonatal hepatitis B vaccination program by adding a dose of passive immunity for newborns of carrier mothers using hepatitis B immunoglobulin (HBIG). During 2006-2012, a total of 148,000 pregnant women were screened for the carrier state of hepatitis B; of this total over 3% were confirmed to be positive. When these data were presented to Georgian health officials, they immediately recognized the magnitude of the problem of hepatitis B infection in Georgian society.

Since roughly 1 in 10 individuals infected with hepatitis B become chronic carriers of surface antigen, the discovered rate of 3% means that among women of childbearing age 30% may have acquired hepatitis B infection to that point in their lives. It is reasonable to assume that the risk of hepatitis B infection extends to all groups of society and not just pregnant women. Amongst healthcare workers the problem of hepatitis B infection may be even more serious because of occupational exposure.

As with all RVF-supported programs, this program was implemented entirely through the existing public health infrastructure by local health care workers, so that from the very start the Ministry of Health and local healthcare workers had full ownership of the program. The government of Georgia  has been providing full funding of the program since 2013.