Cambodia Viral Hepatitis Program Situational Assessment Mission
Viral Hepatitis represents a major cause of death in Cambodia and among patients with primary liver cancer, 44.3% are due to HBV and 43% to HCV. However, the burden of viral hepatitis B and C are still hard to estimate in Cambodia given the limited data currently available. In a recently published meta-analysis on global HBV epidemic in 2015, the prevalence of HBV in Cambodia was estimated to be around 4% with an HBsAg positive population estimated around 580,000 cases. For HVC, another recent meta-analysis conducted by from the Center for Disease Analysis in 2014, reported a lower estimate of the prevalence of HCV chronic infection around 1.7% with at least 182,000 people chronically infected. Additional epidemiologic data will be available soon by the end of 2017 from on-going prevalence studies currently conducted by the University of Health Sciences.
The hepatitis B vaccination coverage is high in Cambodia as 83% of newborn received birth dose administration during the first 24h and 99% three-dose vaccination in 2016. A recent sero-survey in collaboration with the Hiroshima University of Japan in 2017 revealed only 0.55% HBsAg positivity among children aged 5-7 years emphasizing the success of the HBV immunization program held by the National Immunization Program (NIP). However, as discussed earlier under the eMTCT triple elimination item, additional efforts are needed to further improve birth vaccination coverage as well as the potential introduction of additional interventions for EMTCT of hepatitis B.
The MoH of Cambodia is committed also to improving access to hepatitis treatment for the people of Cambodia. A viral hepatitis task force has been recently established at the MoH, and a focal point for viral hepatitis has been appointed at the MoH CDC. A pilot HCV treatment project for co-infected PLHIV and mono-infected people was initiated in 2016 at Kossamak National Hospital in Phnom Penh in collaboration with MSF-France. Clinical guidelines for the treatment of HCV infection among people living with HIV (PLHIV), including the most recent WHO recommendations, have been recently endorsed by the MoH. The GF recently approved the procurement of HCV test kits and anti-HCV drugs for PLHIV under the current HIV grant, and HCV treatment for PLHIV will be implemented soon in other sites in Cambodia.
For the development of the National Hepatitis Strategic Plan in Cambodia, WHO has been assisting the Ministry of Health to conduct disease burden analysis for hepatitis B and C through the modelling of progression and transmission, as well as economic analysis. To further inform the program, Dr Nicole Allard joined a mission to Cambodia in 22-27th October 2017 in collaboration with WPRO, the WHO Cambodia team, WHO HQ and Cambodian Ministry of Health representatives to conduct a systematic situation analysis that could help to design accurate interventions to address hepatitis epidemic in Cambodia, and the findings were subsequently presented to the Director of Health in Cambodia for further consideration.