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Basic Information About Turkey AREA774.815 km 2 POPULATION63,510,000 Urban Population 59,01 % Rural Population 40,99 % 0-14 ages32,7% 15-64 ages62,8 %

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Presentation on theme: "Basic Information About Turkey AREA774.815 km 2 POPULATION63,510,000 Urban Population 59,01 % Rural Population 40,99 % 0-14 ages32,7% 15-64 ages62,8 %"— Presentation transcript:

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2 Basic Information About Turkey AREA km 2 POPULATION63,510,000 Urban Population 59,01 % Rural Population 40,99 % 0-14 ages32,7% ages62,8 % Over 65 4,7 %

3 Basic Information About Turkey LIFE EXPECTANCY AT BIRTH (years) Male65.40 Female70.00 Average67.70 PER CAPITA INCOME2.500 – USD BASIC LİTERACY RATE82%

4 TURKEY TURKEY a country of “intermediate endemicity”for HB infections:  5% HBsAg positive  25-30% Anti-HBs positive  Seroconversion in 1/3 of a 63 million population, and million carriers!

5 At least 10x of annual numbers stated by MoH

6 HBsAg(+) rate if soldier rate (mass vaccinations, crowded living conditions; effect of vaccination?)

7 Regional variations Higher rate of HBsAg positivity in EASTERN regions of TURKEY (crowded families, poor socioeconomic status, infrastructure, lack of access to “sufficient” health services, traditional life-styles...)

8 Regional Differences in HBsAg Positivity 3.7% 6.9% 8.8% 4.6% 8.9% 3.5% 4.9% 4.5% 6.7% 7.9% 4.4%

9 Age of infection: increased after 10 yrs, and peak btw yrs of age

10 Risk groups? No difference btw health personnel and donors regarding HBsAg, but anti-HBs is significantly increased. Patients with chronic hepatitis, cirrhosis and HCC...

11 Horizontal transmission! No known risk factors among 44.5% of AVH cases in Turkey

12 Viral Hepatitis Prevention Society A local NGO with 1,200 members Communication networks targetting health personnel all around the country Important contribution towards the implementation of universal newborn immunization in 1998.

13 Social Marketing of Hepatitis B Immunisation Project Viral Hepatitis Prevention Society In collaboration with Ministry of Health Dept. of Primary Care, opinion leaders from medical schools and PR experts. A baseline KAP (Knowledge, Attitute and Practice) survey was conducted. Regional training teams established. Training materials, leaflets, brochures, posters and a reference guide book for medical doctors and nurses were prepared. Viral Hepatitis Journal, a quarterly medical bulletin was published.

14 Comparison of hepatitis B immunization strategies taking into account cost-effectiveness issues 3 strategies for 1997 cohort of newborns: 1) no vaccination 2) screen mothers and vaccinate newborns 3) vaccinate all newborns

15 Comparison of hepatitis B immunization strategies by cost-effectiveness 1997 cohort ( newborns) No vaccineVaccinate after screening Vaccinate all Number vaccinated Prevented infections Prevented carrier cases Prevented deaths Cost of program USD USD Cost of strategy USD USD USD infected carriers deaths

16 MoH recommendations for HB immunization 1. alternativeDose 1At birth Dose 23 rd month Dose 39 th month 2. alternative (infants born outside health facilities) Dose 13 rd month Dose 24th month Dose 39 th month 3. Alternative (for infants >3 month) Dose 1anytime Dose 21 month after the first dose Dose 35 month after the 2 nd dose

17 In Turkey, universal Hepatitis B immunization is part of EPI since Children are vaccinated at 3, 4 and 9 months of age for Hepatitis B. MoH EPI schedule in Turkey* Vaccines2 mo 3 mo 4 mo 9 mo 15 mo 18 mo BCG X DBT+polioXXX X HepB XXX Measles XX *Haemophilus influenzae type B, MMR, varicella and hepatitis A vaccines are recommended by health personnel, but can be used only upon purchase from private pharmacy by parents. They are not mentioned among EPI vaccines nor covered by any form of insurance.

18 The first year of universal immunization - MoH data Annual no of newborns: Children vaccinated by 3 doses: ~66% Annual no of children immunized:

19 National HB Immunization * First 3 months

20 At the beginning, for the RISK GROUPS, the vaccine required was to be purchased from private pharmacies, and then reimbursed by social security institutions. Since 2000, as a cost-saving measure, MoH started to provide vaccine for risk groups also. Cost of vaccine Pediatric doseAdult dose MoH0,58 USD1,16 USD Private sector14,8 USD17 USD

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22 Two main problems of HB immunization program in Turkey 1 st vaccine dose at 3rd month of life (babies of women that were not screened for HBsAg in pregnancy remain still not protected. However, starting vaccination at birth is problematic for practical reasons.) No program for adolescents


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