JAKARTA - The Ministry of Health (Kemenkes) revealed that more than 60 percent of Indonesians are still vulnerable to hepatitis B infection. Although the national immunization program which started since 1997 has succeeded in reducing transmission in children, adolescents and adults are still at high risk due to not having immunity against the virus.
The Chairman of the Expert Committee on Hepatitis at the Ministry of Health, dr. David H. Muljono, explained that Indonesia is currently experiencing an epidemiological change in hepatitis B. Transmission in the generation who have received immunization since infancy has decreased significantly, but the burden of the disease is still high in the adult age group who were born before the universal immunization program was implemented.
"Indonesia is experiencing an epidemiological change in hepatitis B. Transmission in the generation that received immunization since infancy has decreased drastically, while the burden of the disease in the adult age group still reflects the high transmission that occurred before universal immunization was introduced," said David in Jakarta, Monday.
Vaccination Successfully Press Hepatitis B in Children
Based on the Indonesian Health Survey (SKI) 2023, the prevalence of active hepatitis B (HBsAg) in children aged 1-4 years only reached 0.1 percent, far below the World Health Organization (WHO) target for the elimination of hepatitis B in children.
This success shows that the hepatitis B immunization program is one of the most effective public health interventions ever carried out in Indonesia.
David explained that the distribution of protective antibodies (anti-HBs) shows a different pattern in each age group. High antibody figures were found in children as a result of immunization, then decreased in adolescence and young adulthood, before increasing again in older age groups due to immunity formed after natural infection.
More than 60 Percent of the Population Does Not Have Immunity
SKI 2023 data also shows that the prevalence of active hepatitis B nationwide reaches 2.4 percent. As many as 19.7 percent of the population have evidence of having been exposed to the hepatitis B virus (positive anti-HBc), while only 24.3 percent have protective antibodies (positive anti-HBs).
Of concern, more than 60 percent of Indonesians do not have the three hepatitis B serology markers, namely HBsAg, anti-HBc, and anti-HBs. This means that this group has never been infected, but also has no immunity to the hepatitis B virus.
"These findings show that hepatitis B transmission has decreased significantly compared to the previous two decades, but there is still a large proportion of people who do not have immunity to hepatitis B infection," said David.
According to him, as long as horizontal transmission still occurs in the community, groups that do not have immunity are still at risk of being infected when entering adolescence and adulthood.
Ministry of Health Promotes Screening and Catch-up Vaccination
David emphasized that the strategy for eliminating hepatitis in Indonesia is no longer enough to rely solely on infant immunization. Control efforts need to be expanded with an approach that includes prevention of new infections to prevention of complications such as cirrhosis and liver cancer.
The strategy includes expanding risk-based screening, increasing access to laboratory examinations, early diagnosis, management according to national and WHO guidelines, prevention of transmission within the family, and catch-up vaccination for people who do not have immunity against hepatitis B.
In addition, David said the WHO 2024 guidelines have expanded the recommendations for antiviral therapy for chronic hepatitis B patients so that more patients can receive treatment before the disease progresses to cirrhosis or liver cancer.
The Role of All Parties Is Needed
The Ministry of Health assessed that Indonesia's success in suppressing hepatitis B in children is proof that science-based policies are able to change the epidemiology of the disease in one generation.
Therefore, David invited all stakeholders, from the government, academics, professional organizations, to the media, to work together to increase public awareness about the importance of hepatitis B prevention, early detection, and treatment.
"Indonesia has proven that hepatitis elimination is not an impossible goal. The success of achieving the WHO target in children shows that evidence-based policies can change the epidemiology of a disease in one generation," he concluded.
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