Improvement Needed to Reduce Hepatitis B Virus Prevalence Worldwide

Access to diagnosis and treatment must be improved worldwide to meet target goals for the elimination of viral hepatitis.

Approximately 292 million individuals worldwide may be infected with hepatitis B virus (HBV), according to a study published in The Lancet Gastroenterology & Hepatology.1 Although some countries are on track to reach target goals for disease elimination, improvement is still needed to decrease chronic HBV prevalence in many other regions.

Despite having no cure, highly effective therapies for HBV have been introduced with the potential to control viral replication and prophylaxis, and minimize transmission, making disease elimination a possibility. According to the study, the 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. However, a new modelling study indicates that access to diagnosis and treatment worldwide needs to be improved to meet global targets.

In the study, the researchers used a Delphi process with a literature review and expert interviews to develop models of HBV surface antigen prevalence, prophylaxis, diagnosis, and treatment across 120 countries. In 2016, a total of 291,992,000 individuals were infected with HBV, approximately 3.9% of the world’s population. Of these infections, around 10% were diagnosed, and only 5% of 94 million individuals eligible for treatment received antiviral therapy. Approximately 1.4% of these infections were in children 5 years of age.

The researchers estimated that 87% of infants had received the 3-dose HBV vaccination in their first year of life, 46% had received timely birth-dose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load were administered antiviral therapy to reduce mother-to-child transmission, according to the study.

Of the modeled countries, 94 were estimated to have already met the 2020 target of 1% prevalence among children aged 5 years, and 46 have already met the 2030 target of 0.1% prevalence. However, many other countries have yet to meet these target goals and have yet to introduce timely birth-dose vaccination, the researchers noted.

In an accompanying editorial, the authors indicated that the data are illustrative of the work that needs to be done to decrease chronic HBV infection globally.2 Implementing birth-dose vaccination is crucial to reducing mother-to-child transmission, they noted.

Unless appropriate prevention at birth is applied and improved screening and linkage to care are implemented, incidences of new chronic HBV infections will continue to increase, the authors concluded.

Reference

1. Razavi-Shearer D, Razavi H, Gamkrelidze I, et al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. The Lancet Gastroenterology & Hepatology. Published March 26, 2018. https://doi.org/10.1016/S2468-1253(18)30056-6

2. Dusheiko G, Agarwal K. Delineating the global challenges of hepatitis B virus infection. The Lancet Gastroenterology & Hepatology. Published March 26, 2018. Doi: https://doi.org/10.1016/S2468-1253(18)30093-1