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J Korean Med Sci. 2015 Nov;30(11):1584-8. doi: 10.3346/jkms.2015.30.11.1584. Epub 2015 Oct 16.

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy.

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Medizinische Klinik Nord, Klinikum Dortmund, Dortmund (Academic Teaching Hospital of the Westfälische Wilhelms-Universität Muenster, Muenster, Germany) and Medical Mission Institute, Wuerzburg, Germany.
Medical Mission Institute, Wuerzburg, Germany.


In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.


Democratic People's Republic of Korea; Esophagoscopy; Hepatitis B; Mass Vaccination

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