Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study.

Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment. Methods In this modelling study, we used a Delphi process that included a literature review in PubMed and Embase, followed by interviews with experts, to quantify the historical epidemiology of HBV infection. We then used a dynamic HBV transmission and progression model to estimate the country-level and regional-level prevalence of HBsAg in 2016 and the effect of prophylaxis and treatment on disease burden. Findings We developed models for 120 countries, 78 of which were populated with data approved by experts. Using these models, we estimated that the global prevalence of HBsAg in 2016 was 3\ub79% (95% uncertainty interval [UI] 3\ub74\u20134\ub76), corresponding to 291992000 (251513000\u2013341114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4\ub78 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1\ub78 (1\ub76\u20132\ub72) million infections were in children aged 5 years, with a prevalence of 1\ub74% (1\ub72\u20131\ub76). We estimated that 87% of infants had received the three-dose HBV vaccination in the first year of life, 46% had received timely birthdose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load had received antiviral therapy to reduce mother-to-child transmission. Interpretation Our estimate of HBV prevalence in 2016 differs from previous studies, potentially because we took into account the effect of infant prophylaxis and early childhood vaccination, as well as changing prevalence over time. Although some regions are well on their way to meeting prophylaxis and prevalence targets, all regions must substantially scale-up access to diagnosis and treatment to meet the global targets

Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022 : a modelling study

Abstract: Background: The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. Methods: In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. Findings: We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3\ub72% (95% uncertainty interval 2\ub77\u20134\ub70), corresponding to 257\ub75 million (216\ub76\u2013316\ub74) individuals positive for HBsAg. Of these individuals, 36\ub70 million were diagnosed, and only 6\ub78 million of the estimated 83\ub73 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0\ub77% (0\ub76\u20131\ub70), corresponding to 5\ub76 million (4\ub75\u20137\ub78) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission