Gish Robert G, Sollano Jose D, Lapasaran Alex, Ong Janus P
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA.
National Viral Hepatitis Roundtable, San Francisco, California, USA.
J Gastroenterol Hepatol. 2016 May;31(5):945-52. doi: 10.1111/jgh.13258.
Multiple studies have shown a high prevalence of chronic hepatitis B (CHB) infection in the Philippines, not only in high-risk populations but also in the general population. The most recent national study estimated HBsAg seroprevalence to be 16.7%, corresponding to an estimated 7.3 million CHB adults. The factors underlying the high prevalence of CHB and its sequelae include the inadequate use of vaccination for prevention and the lack of treatment for many Filipinos. Because without medical monitoring and treatment of CHB the risk of progression to liver failure and death is 25-30%, the ultimate medical and societal costs will be very high if the Philippines fails to properly address hepatitis B infection. It will be very important to move forward with programs that can help to ensure universal vaccination of newborns, screening and vaccination nationwide, and monitoring and treatment for CHB persons. It will also be crucial to address transmission of HBV in the health-care setting (via contaminated needles and syringes and inadequately sterilized hospital equipment) and via injection drug use and tattooing. Because of the relatively low average per capita income and the lack of coverage by PhilHealth of outpatient visits and medications, there is an urgent need to move forward with a nationally supported program that includes education for both the general public and health-care workers on liver disease and screening for hepatitis viruses, followed by, as appropriate, vaccination or treatment, with expanded government coverage for these for all those who could not otherwise afford it.
多项研究表明，慢性乙型肝炎（CHB）感染在菲律宾的患病率很高，不仅在高危人群中如此，在普通人群中亦是如此。最近的一项全国性研究估计，乙肝表面抗原（HBsAg）血清阳性率为16.7%，这意味着约有730万成年慢性乙肝患者。慢性乙肝及其后遗症患病率高的潜在因素包括预防疫苗接种使用不足以及许多菲律宾人缺乏治疗。由于如果不对慢性乙肝进行医学监测和治疗，发展为肝衰竭和死亡的风险为25%-30%，如果菲律宾不能妥善应对乙肝感染问题，最终的医疗和社会成本将非常高昂。推进有助于确保新生儿普遍接种疫苗、在全国范围内进行筛查和接种疫苗以及对慢性乙肝患者进行监测和治疗的项目将非常重要。解决医疗环境中乙肝病毒的传播（通过受污染的针头和注射器以及未充分消毒的医院设备）以及通过注射吸毒和纹身传播也至关重要。由于人均收入相对较低，且菲律宾健康保险公司（PhilHealth）对门诊就诊和药物治疗的覆盖不足，迫切需要推进一项由国家支持的项目，该项目包括对普通公众和医护人员进行肝病教育以及肝炎病毒筛查，随后根据情况进行疫苗接种或治疗，并扩大政府对所有无力承担费用者的覆盖范围。
