1
HEALTH SERVICES DELIVERY
1.4
DISEASE CONTROL PROGRAMME
1.4.2.d.4
Communicable Diseases Control: Immunizable Diseases Control:
Viral Hepatitis Prevention & Control (as of March 2008)
A
B
Focal Point
Implementing Agencies
C
Target Areas & Beneficiaries
Epidemiology Unit
Epidemiology Unit
Provincial Director of Health Services
Regional Director of Health Services
Medical Officer of Health
Curative Care Institutions (All hospitals)
Target Areas: MOH Areas, Curative Care Institutions
Beneficiaries: Community in respective MOH areas,
Health workers of curative care institutions
Project Summary:
Viral hepatitis (VH) comprises of at least five disease entities, which are indistinguishable clinically, yet
totally different aetiologically and pathologically. Hepatitis A accounts for the majority of cases in the
country. In addition, serious consequences of hepatitis B have been identified as emerging public health
issues. Therefore it is important to have a national programme on control and prevention of VH with
following activities:








1.
Assess burden of VH in the country
Establish a National Task force on control and prevention of VH in Sri Lanka
Strengthen surveillance (particularly laboratory surveillance) of VH
Improve excreta disposal system at local settings
Ensure safe drinking water
Introduce of Hepatitis A vaccine for high risk groups
Strengthen law enforcement in order to ensure environmental sanitation
Ensure universal infant immunization against hepatitis B
Justification:
Viral Hepatitis (VH) is one of the notifiable diseases in Sri Lanka. Hepatitis A is the
commonest type of viral hepatitis in the country. It is endemic in almost all parts of Sri Lanka,
and occurs throughout the year. The average annual admission rate to government hospitals in
Sri Lanka for VH is 22.5 per 100,000 populations in 2001. However, the actual incidence of
VH is likely to be more than that of reported numbers. The hospital mortality rate is 0.4%.
Data on other types of VH in Sri Lanka are limited. Prevalence of hepatitis B and C ranges
from 0.27% to 2.5% and 0.56% to 0.97% respectively. These data are based on
epidemiological and serological surveys done in defined geographical areas in the country.
Health
authorities
have
not
given
sufficient
priority
for
prevention
and
control of VH. Laboratory surveillance of VH is limited due to many constraints. Direct
and indirect impact of socioeconomic and political /administrative re-organization on public
health issues, such as unsafe water, unauthorized constructions on increase of VH in the
country are significant. There is a timely need to have a functioning national programme on
control & prevention of VH in Sri Lanka. This programme has to cover all possible aspects,
where active intervention could be implemented.
2.
Important Assumptions/ Risks/ Conditions:
Assumptions:
 Government commitment and policy to prevent and control VH
 Commitment by the Department of Health with the other sectors, such as local
government to control and prevent VH, as a priority in public health
 Public need to have a active programme on control and prevention of VH and their
support and active participation into the programme
Risk / Conditions:

3.
Cost: Screening for types of VH, injection safety practices and immunization are
important strategies in implementing a successful preventive and control programme.
However, this will require an additional financial commitment by the Ministry and
inability to provide such facilities would affect the expected outcome.
Project Objective:
Objective
Indicators
Prevention
and  Morbidity and mortality
Control of Viral Hepatitis of VH
in Sri Lanka
4.
Means of Verification
 Survey: review of
Medical statistician and
Institution records / community
survey
Project Output/Product:
Outputs
VH morbidity and mortality
reduced



Indicators
Hospital admission rate
MOH notifications
Case Fatality Rate of VH
All
infants
immunized  % immunized
against Hep B and the high
risk groups
immunized
against Hep B and Hep A
Universal
precautions  % of immunizations
strengthened with regard to performed
with Auto
all invasive
procedures Disable(AD) syringes
at all medical institutions
/ clinics
VH
surveillance  Notification rate of VH
strengthened
 Timeliness notification
Means of Verification
Review
data
at Epidemiology
Unit
and Medical Statistician
records
 Record and returns



Hospital records
Epidemiology Unit
Review
at Epidemiology

data
Unit
Timeliness and
completeness of special
investigations
 Notification of VH from
private sector
surveillance  Number of
functioning Provincial /
district laboratories with
facility to
carry out
VH investigations
 %
of laboratory
confirmed cases

Laboratory
strengthened
5.
Hospital
and
laboratory based survey

Related Projects:
Project No.
6.
and Medical Statistician
records
Project Title
Hepatitis B Immunization Programme for infants and selected high risk groups:
(ongoing)
Hepatitis A Immunization Programme for high risk groups
Injection safety programme – Provision of Auto-disable syringes (ongoing)
Provision of Safe Drinking Water
Provision of hygienic latrine facility
Provision of laboratory facility at the Provincial / district level for VH
laboratory investigations
Relevant Agencies to be Coordinated:
Ministry of Local Government and Public Administration, Ministry of Education, Ministry of Water
Supply and Drainage, All Provincial councils and other related Ministries
7.
Monitoring & Evaluation:
1. Who? Director General of Health Services and Epidemiology Unit
2. When? Quarterly
3. What actions to be taken based on results of monitoring & evaluation?
Continues reviews with Provincial / District / Divisional Health Authorities
Periodical reviews with other relevant agencies to be coordinated
8. Activities:
Activities
1
Establish a National Task Force
Control and Prevention of VH
Expected Results
for
Policy formulation /
Implementation level
coordination
M & E major activities at
Process Indicators
Regular quarterly meeting
2
3
Conduct VH Burden study (Part of this
study will be based on secondary data)
Establish Hepatitis B Immunization
Programme
4
Establish Hepatitis A Immunization
Programme for high risk groups
5
Establish Injection safety programme –
Provision of
Auto-disable syringes (ongoing)
6
Strengthen VH Surveillance
7
Provide of laboratory facility at the
Provincial/ District level for VH
laboratory investigations
8
Establish and maintain a surveillance
system to maintain water quality
national level
To estimate morbidity,
mortality and disabilities
caused by each type
of VH in the country
Cost analysis for patient
management at the
government
medical institutions
Immunization of all
infants against Hepatitis B
Immunization of all high
risk groups/adolescents
against Hepatitis B
Immunization of all high
risk groups against Hepatitis
A
Use AD syringes for all
immunizations
Improved notification of
VH (both State & Private
sector)
Investigation of all VH
outbreaks
Early prediction of out
breaks
Strengthened laboratory
Surveillance
Surveillance on water
quality established
Final report to be made
available before end of
year 2005
95% coverage by 2005;
100% in 2007 & 2010
50% coverage by 2006;
60% in 2008; 70%
in
2010
50% coverage by 2006;
60% in 2008
70% in 2010
100% EPI vaccines by
2005
100% Non EPI Vaccine by
2007
% Notification ra
Timeliness &
completeness
% of outbreaks investigated
% of outbreaks predicted
Functioning laboratory
by province by 2010
> 50% reported cases are
confirmed by laboratory
tests by 2010
100% Timeliness and
completeness of laboratory
reports by
2010
% of districts which have
the surveillance on water
quality established