Hepatitis B Vaccination Program Demonstrates Positive Impact

WHO has released a global plan for hepatitis B elimination by 2030, including goals to increase pediatric and maternal immunization and to improve screening and treatment.

A recent modeling study found that China’s hepatitis B virus (HBV) immunization program has substantially improved the epidemic of hepatitis B virus after about 30 years of implementation. The findings may aid with design programs in other countries and could help achieve the World Health Organization’s (WHO) 2030 targets.

Globally, HBV is a major threat to public health due to its high transmissibility and the elevated incidence of chronic persistent and adverse outcomes. Approximately 296 million individuals were living with chronic HBV infection in 2019, leading to around 820,000 deaths globally. Despite these concerns, control of HBV is largely neglected and is not a political priority in many countries.

Given the global burden of the virus, WHO has released a global plan for HBV elimination by 2030. The plan includes goals to increase pediatric and maternal immunization and to improve screening and treatment. If achieved, these steps would reduce annual incidence of HBV by 90% and would achieve 90% vaccination coverage by 2030.

China accounts for approximately 30% of the global HBV burden and has been classified as a medium-high HBV endemic area by the WHO. Evaluating China’s containment plan can not only further the push to eliminate HBV, but the authors added that it can also provide valuable insights for similar countries.

To evaluate the immunization program, investigators constructed an expanded Susceptible-Exposed-Infectious-Recovered (SEIR) model and decision tree-Markov model to estimate the epidemic in China and assess the feasibility of the WHO 2030 goals. Two models were separately used to evaluate the impact and cost-effectiveness of the HBV vaccine.

Between 1990 and 2020, the researchers found that the number of chronic HBV infections in China decreased by 33.9%. If the current status quo continued, there would be 55.73 million infections (3.95% prevalence) in 2030, compared to 90.63 million (6.42% prevalence) without the National Immunization Program. Similarly, there would be 114.78 million infections (8.13% prevalence) without any interventions.

The prevention of mother-to-child transmission (PMTCT) strategy showed a significant financial net benefit of $12,283.50 per person. This equates to a benefit-cost ratio of 12.66, which is higher than that of universal vaccination at 9.49. Compared with no screening or vaccination, the study found that the PMTCT strategy could save $7726.03 for each quality-adjusted life-years increase.

Based on these findings, the authors concluded that the HBV vaccination program has had a significant positive impact on controlling the epidemic, both in terms of efficacy and the economy. They suggested that Chinese officials should focus on exploring strategies to improve diagnosis and treatment coverage in order to reduce the number of HBV-related deaths.

Despite these encouraging results, however, the authors said that even continuous efforts in the prevention and control of hepatitis could narrowly miss the WHO targets by 2030 without further efforts. To fulfill the target, the investigators said enhancing the PMTCT strategy and infant vaccination could be effective.

REFERENCE

Liu Z, Lli M, Hutton D, Wagner A, Yao Y, Zhu W, et al. Impact of the national hepatitis B immunization program in China: a modeling study. Infectious Diseases of Poverty. October 11, 2022. Accessed October 21, 2022. https://idpjournal.biomedcentral.com/articles/10.1186/s40249-022-01032-5