1. Epidemiology and Control Programs for HBV Infection. Yousef Qari, MD, FRCP(C), ABIM Gastoenterologist King Abdulaziz University Hospital

3. Epidemiology of Hep B Worldwide 2 billion people are infected with this virus 350 million Chronic HBV infection. 10th leading cause of death in the world

4. Route of Transmission of HepB High endemicity –Perinatal (vertical) –Acquired in preschool years. Low endemicity –Early adult life Intravenous drug use Unprotected sexual activities

5. Worled Prevalence of Hep B

6. Based on pooled data from surveys in Saudi Arabia up to 1988 PROVINCE NUMBER OF MALESTESTED % POSITIVE NUMBER OF FEMALES FEMALESTESTED % POSITIVE Central21556.944944.1 Southwest159313.856423.9 Eastern7838114628.2

7. The prevalence of HBsAg and other markers of HBV among residents of Jizan Ayoola AE Saudi Med J. 2003; 24(9):991-5

8. HBV and HCV prevalence among dialysis patients in Bahrain and Saudi Arabia Qadi AA Am J Infect Control. 2004; 32(8):493- 5 (ISSN: 0196-6553)Am J Infect Control. 2004; 32(8):493- 5

9. A chronology of hepatitis B programmes in Saudi Arabia PROGRAMME TYPE YEAR OF IMPLEMENTATION Mandatory Mandatory All newborns (0-1 year) 1989 All newborns (0-1 year) 1989 Children at school entry (6-7 years) 1990 Children at school entry (6-7 years) 1990 Voluntary Voluntary Pre-school children (1-5 years) 1990 / 1991 Pre-school children (1-5 years) 1990 / 1991 Health personnel (adults) 1990 Health personnel (adults) 1990 Others 1989 Others 1989

10. HBV prevalence had declined among Saudi children eight years after the integration of the hepatitis B vaccine into the national EPI. Al-Faleh FZ et al, B. J Infect 1992; 24;197-206. Al-Faleh FZ et al.. J Infect 1999; 38:167-170.

11. The decline of hepatitis B viral infection in South- Western Saudi Arabia. Ayoola AE Saudi Med J. 2003; 24(9):991-5

12. Prevalences of HBsAg and anti-HCV among Saudi donors before and after the adoption of the revised AABB blood donation guidelines. Clinical and Diagnostic Laboratory Immunology, November 2003, p. 1159-1160, Vol. 10, No. 6

13. Prevalence of HBV, HCV among blood donors in a teaching hospital in the Central region of Saudi Arabia. 24000 patients El-Hazmi MM Saudi Med J. 2004; 25(1):26-33 Saudi Med J. 2004; 25(1):26-33

14. There has also been a significant decline of HBV markers among unvaccinated Saudi adults Declining HBsAg prevalence in asymptomatic adults in Gizan (%) 198519921997 Males19.99.45.8 Females9.36.14.2 Total13.97.75.1

15. Hepatocellular carcinoma in Saudi Arabia: Role of hepatitis B infection. N=118 Ayoola EA J Gastroenterol Hepatol. 2004; 19(6):665-9 J Gastroenterol Hepatol. 2004; 19(6):665-9 1.9 per 1000 (2.3 in men, 1.2 in women).

16. Natural History of Hep B HBV Infection Chronic Hepatitis Cirrhosis HCC 15-40% HBV

17. The real challenge To decrease the incidence of HCC in our population by decreasing the prevalence of Hepatitis B. To decrease the incidence of HCC in our population by decreasing the prevalence of Hepatitis B.

18. Conclusion According to the EPI programmes, all Saudi citizens under the age of 26 years should have been vaccinated by the year 2008. The low prevalence of HBsAg in children, provides evidence for the effectiveness and efficacy of the integration of hepatitis B vaccination into the extended program of immunization in KSA.

19. Conclusion The significant decline of HBV markers among unvaccinated Saudi adults indicated an indirect effect of other factors like health education and socio-economic progress The ongoing program of HBV vaccination may significantly decrease the prevalence of HBV-associated HCC in Saudi Arabia