Mass vaccination of health workers in Peru.

When Peru's government committed to immunizing the country's 350 000 health-care workers against hepatitis B, many policy-makers expected the greatest challenge to be logistics. Naomi Mapstone reports. This Andean nation of 29 million people has one of the most diverse geographies in the world, with 25 regional health departments overseeing services for the sprawling capital of Lima, as well as remote villages in the high mountain ranges of La Sierra and pockets of the Amazon rainforest accessible only by boat. Poor infrastructure and social protest, involving tactics such as cutting road and rail access, can present further obstacles to planners, especially when trying to reach isolated indigenous communities. " Peru has intermediate endemic-ity of hepatitis B, with areas of both high and low endemicity that have left the country with high rates of liver cirrhosis and liver cancer, " says Dr Manuel Peña, the Pan American Health Organization (PAHO) representative in Peru. " The annual mortality rate from liver cirrhosis is 10.45 per 100 000 population and mortality rate from liver cancer is 0.98 per 100 000 population. In endemic areas, about 7% of deaths from liver disease are related to hepatitis B infection, including liver cancer, cirrhosis and fulminant hepatitis. " While the need for action was clear, rolling out such a large-scale project meant liaising between the state, private enterprise and civil society groups, says Peña. " To ensure the availability of vaccines in all health facilities in the country we used the logistic systems of the Ministry of Health as well as the Ministry of Social Security, the armed forces and some health institutions in the private sector, " he says. The campaign kicked off in 2008, making Peru the first country in the world to start working towards the goal of full hepatitis B vaccine coverage for health-care workers under the Global Plan of Action on Workers' Health, which was set at the 2007 World Health Assembly. The World Health Organization (WHO) estimates that occupational exposure to hepatitis B – mainly from needlestick injuries – accounts for some 37% of the disease burden among health-care workers worldwide and that 95% of this fraction of the burden can be prevented with immunization. In the United States of America, after mandatory hepatitis B vaccination was introduced for health-care workers in 1992, annual cases dropped significantly from 17 000 in 1983 to 400 in 1995, according to research published …