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Predictions of the emergence of vaccine-resistant hepatitis B in The Gambia using a mathematical model

By J. N. Wilson, D. James Nokes and W. (William) Carman


Vaccine escape variants of hepatitis B virus (HBV) have been identified world-wide. A mathematical model of HBV transmission is used to investigate the potential pattern of emergence of such variants. Attention is focused on The Gambia as a country with high quality epidemiological data, universal infant immunization and in which escape mutants after childhood infections have been observed. We predict that a variant cannot become dominant for at least 20 years from the start of vaccination, even when using a vaccine which affords no cross protection. The dominant factor responsible for this long time scale is the low rate of infectious contacts between infected and susceptible individuals (we estimate the basic reproduction number of hepatitis B in The Gambia to be 1·7). A variant strain that achieves high prevalence will also take many years to control, and it is questionable whether emergence will be identifiable by sero-surveillance until of high prevalence. The sensitivity of the model predictions to epidemiological and demographic factors is explored

Topics: RA0421
Publisher: Cambridge University Press
Year: 2000
OAI identifier:

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  6. (1995). Molecular epidemiology of hepatitis B virus vaccine variants in Singapore. Vaccine doi
  7. (1995). Fulminant reactivation of hepatitis B due to envelope protein mutant that escaped detection by monoclonal HBsAg ELISA. Lancet doi
  8. (1992). Mutations within the S gene of hepatitis B virus transmitted from mothers to babies immunized with hepatitis B immune globulin and vaccine. Pediatr Res doi
  9. (1994). Breakthrough infections and identi®cation of a viral variant in Gambian children immunized with hepatitis B vaccine. doi
  10. (1994). Genetic and biological characterization of two hepatitis B variants: a precore mutant implicated in fulminant hepatitis and a surface mutant resistant to immunoprophylaxis.InternationalSymposiumonViral Hepatitis and Liver Disease, doi
  11. (1990). WHO strategy for the global elimination of new cases of hepatitis B. Vaccine doi
  12. (1996). The transmission dynamics and control of hepatitis B virus in The Gambia. Stat Med doi
  13. (1995). evolution and changes in the efficacy of vaccines ± a theoretical framework. doi
  14. (1999). The predicted pattern of emergence of vaccine-resistant hepatitis B: a cause for concern? Vaccine doi
  15. (1993). The in¯uence of age on the development of the hepatitis B carrier state.
  16. (1991). Infectious diseases of humans: dynamics and control.
  17. (1994). Modelling the impact of mass vaccination against hepatitis B. I. Model formulation and parameter estimation. doi
  18. (1992). Competition between zido vudine-sensitive and zidovudine-resistant strains of HIV. AIDS doi
  19. (1993). Imperfect vaccines and herd immunity to HIV. doi
  20. (1995). Long-term efficacy of continuing hepatitis B vaccination in infancy in two Gambian villages. Lancet doi
  21. (1996). Vaccination against hepatitis B virus in highly endemic areas: waning vaccine-induced immunity and the need for booster doses. Trans R Soc Trop Med Hyg doi
  22. (1996). Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas. Epidemiol Infect doi
  23. (1983). Housing Census doi
  24. (1985). Age-related changes in the rate of disease transmission: implications for the design of vaccination programmes. doi
  25. The epidemiology and control of hepatitis B virus in highly endemic areas.
  26. (1989). Mutation rate of the hepadnavirus genome. Virology doi
  27. (1994). Superinfection and the evolution of parasite virulence. doi
  28. (1995). Pathogen coexistence induced by density-dependent host mortality.
  29. (1998). Cross immunity and vaccinationagainstmultiple microparasitestrains.

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