Summary
Collaborators
Polaris Observatory Collaborators: Devin Razavi-Shearer, Ivane Gamkrelidze, Mindie H Nguyen, Ding-Shinn Chen, Pierre Van Damme, Zaigham Abbas, Maheeba Abdulla, Antoine Abou Rached, Danjuma Adda, Inka Aho, Ulus Akarca, Fuad Hasan, Faryal Al Lawati, Khalid Al Naamani, Hamad Ibrahim Al-Ashgar, Seyed M Alavian, Sameer Alawadhi, Agustin Albillos, Said A Al-Busafi, Soo Aleman, Faleh Z Alfaleh, Abdulrahman A Aljumah, Anil C Anand, Nguyen Thu Anh, Joop E Arends, Perttu Arkkila, Kostas Athanasakis, Abate Bane, Ziv Ben-Ari, Thomas Berg, Abdul R Bizri, Sarah Blach, Carlos E Brandão Mello, Samantha M Brandon, Bisi Bright, Philip Bruggmann, Maurizia Brunetto, Maria Buti, Henry L Y Chan, Asad Chaudhry, Rong-Nan Chien, Moon S Choi, Peer B Christensen, Wan-Long Chuang, Vladimir Chulanov, Mette R Clausen, Massimo Colombo, Markus Cornberg, Benjamin Cowie, Antonio Craxi, Esther A Croes, Diego Alberto Cuellar, Chris Cunningham, Hailemichael Desalegn, Sylvia Drazilova, Ann-Sofi Duberg, Steve S Egeonu, Manal H El-Sayed, Chris Estes, Karolin Falconer, Maria L G Ferraz, Paulo R Ferreira, Robert Flisiak, Sona Frankova, Giovanni B Gaeta, Javier García-Samaniego, Jordan Genov, Jan Gerstoft, Adrian Goldis, Ilias Gountas, Richard Gray, Mário Guimarães Pessôa, Behzad Hajarizadeh, Angelos Hatzakis, Christophe Hézode, Sayed M Himatt, Andy Hoepelman, Irena Hrstic, Yee-Tak T Hui, Petr Husa, Rohani Jahis, Naveed Z Janjua, Peter Jarčuška, Jerzy Jaroszewicz, Sabahattin Kaymakoglu, David Kershenobich, Loreta A Kondili, Aliya Konysbekova, Mel Krajden, Pavol Kristian, Wim Laleman, Wai-Cheung C Lao, Jen Layden, Jeffrey V Lazarus, Mei-Hsuan Lee, Valentina Liakina, Young-Suk S Lim, Ching-Kong K Loo, Boris Lukšić, Reza Malekzadeh, Abraham O Malu, Adkhamjon Mamatkulov, Michael Manns, Rui T Marinho, Mojca Maticic, Stefan Mauss, Muhammad S Memon, Maria C Mendes Correa, Nahum Mendez-Sanchez, Shahin Merat, Ammal M Metwally, Rosmawati Mohamed, Jacques E Mokhbat, Christophe Moreno, Joel Mossong, Fadi H Mourad, Beat Müllhaupt, Kimberly Murphy, Erkin Musabaev, Arif Nawaz, Helen M Nde, Francesco Negro, Alexander Nersesov, Van Thi Thuy Nguyen, Richard Njouom, Renovat Ntagirabiri, Zuridin Nurmatov, Solomon Obekpa, Ponsiano Ocama, Stephen Oguche, Ogu Omede, Casimir Omuemu, Ohene Opare-Sem, Christopher K Opio, Necati Örmeci, George Papatheodoridis, Ken Pasini, Nikolay Pimenov, Hossein Poustchi, Trân D Quang, Huma Qureshi, Alnoor Ramji, Kathryn Razavi-Shearer, Berhane Redae, Henk W Reesink, Cielo Yaneth Rios, Gabriela Rjaskova, Sarah Robbins, Lewis R Roberts, Stuart K Roberts, Stephen D Ryder, Rifaat Safadi, Olga Sagalova, Riina Salupere, Faisal M Sanai, Juan F Sanchez-Avila, Vivek Saraswat, Christoph Sarrazin, Jonathan D Schmelzer, Ivan Schréter, Julia Scott, Carole Seguin-Devaux, Samir R Shah, Ala I Sharara, Manik Sharma, Gamal E Shiha, Tesia Shin, William Sievert, Jan Sperl, Peter Stärkel, Catherine Stedman, Vana Sypsa, Frank Tacke, Soek S Tan, Junko Tanaka, Krzysztof Tomasiewicz, Petr Urbanek, Adriaan J van der Meer, Hans Van Vlierberghe, Stefano Vella, Adriana Vince, Yasir Waheed, Imam Waked, Nicholas Walsh, Nina Weis, Vincent W Wong, Joseph Woodring, Cesar Yaghi, Hwai-I Yang, Chung-Lin Yang, Kakharman Yesmembetov, Ayman Yosry, Man-Fung Yuen, Muhammed Aasim M Yusuf, Stefan Zeuzem, Homie Razavi
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 3·9% (95% uncertainty interval [UI] 3·4–4·6), corresponding to 291 992 000 (251 513 000–341 114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4·8 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1·8 (1·6–2·2) million infections were in children aged 5 years, with a prevalence of 1·4% (1·2–1·6). We estimated that 87% of infants had received the three-dose HBV vaccination in the 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 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.
Funding
John C Martin Foundation