Target to eliminate hepatitis B by 2030 may be unrealistic

The goal of global elimination of hepatitis B virus (HBV) by 2030 is currently unrealistic for many countries affected by chronic viral diseases. New data from collaborators at the multinational nonprofit Polaris Observatory show that across 170 countries, fewer than 1 in 10 patients eligible for hepatitis B treatment actually receive it.¹

The findings corroborate public health discussions about the shortcomings of current hepatitis B mitigation and elimination models in particularly affected countries and highlight the need to strengthen hepatitis B-specific diagnostic and treatment strategies globally.

A team of Polaris Observatory collaborators, led by Devin Razavi-Shearer, associate director of the CDA Foundation’s Hepatitis B and Delta Program, sought to provide national, regional, and global estimates of HBV prevalence in the general population, and associated HBV infections. Rate. Diagnosis, treatment, prevention and estimated burden of hepatitis B globally.

As mentioned previously, in 2016 the World Health Assembly endorsed a public health initiative to eliminate hepatitis B virus infection as a global health threat by 2030, building on existing treatments such as antiviral drugs and prevention , making “the elimination of hepatitis B virus infection feasible even in the absence of effective treatments.” Virological treatment. “

Razavi-Shearer and colleagues used a Delphi method combined with literature review and interview data to conduct a modeling study of HBV infection prevalence, diagnosis, treatment, and prevention strategies. Relevant interview data comes from conversations with national health experts.

The team also used dynamic Markov models to estimate national, regional and global HBV infection prevalence in 2022, and the impact of treatment and prevention on the overall disease burden. The researchers further estimated the incidence of future morbidity and mortality in the absence of other interventions.

Their final model included 170 countries. It is estimated that the number of HBsAg-positive people worldwide is 275.5 million (95% CI, 216.6 – 316.4), equivalent to a global HBV prevalence of 3.2% (95% CI, 2.7 – 4.0).

Of the estimated patient population, only 36 million (13.1%) have been diagnosed with HBV. An estimated 83.3 million people are eligible for antiviral treatment, of whom only 6.8 million are receiving such care (8.2%).

Hepatitis B virus is estimated to affect 5.6 million children worldwide (95% CI, 4.5 to 7.8) – with a global prevalence of 0.7% (95% CI, 0.6 to 1.0). Latest data estimate that while 85% of infants receive the recommended 3 doses of hepatitis B vaccine before their first birthday, less than half (46%) receive the birth dose of hepatitis B vaccine in time.

Another 14% of infants received hepatitis B immune globulin in addition to full vaccination, and only 3% of mothers with higher viral loads received antiviral treatment to reduce the risk of mother-to-child transmission.

These latest global estimates are consistent with recent regional reports from areas with higher HBV prevalence, including Africa, where investigators from the Centers for Disease Control and Prevention (CDC) report that only one-third of countries on the continent have reached ≥90% of infant hepatitis B vaccine coverage in 2021.²

“Strategies to expand the introduction of (birth-dose hepatitis B vaccine) and timely increase (birth-dose hepatitis B vaccine) and (three-dose hepatitis B vaccine) coverage will accelerate reductions in preventable hepatitis B-related morbidity and mortality and achieve progress by 2030 Progress toward hepatitis B elimination goals,” the CDC team wrote at the time.

Razavi-Shearer and colleagues similarly concluded that mitigation and prevention measures must be strengthened within the public health goal of eliminating the threat of hepatitis B.

“As 2030 approaches, many countries remain out of reach of elimination targets under the current framework,” they wrote. “Despite the greatest success of preventive measures, increased efforts and enhanced diagnosis and treatment are needed to achieve elimination. Target.”

refer to

1. ^{Polaris Observatory collaborator. Global prevalence, cascades of care and prevention coverage for hepatitis B in 2022: a modeling study (published online ahead of print, July 27, 2023). Lancet Gastroenterol Liver. 2023;S2468-1253(23)00197-8. Number: 10.1016/S2468-1253(23)00197-8}
2. ^{Kunzmann K. Africa faces the challenge of mother-to-child transmission of hepatitis B. HCPLive. Published on July 21, 2023. https://www.hcplive.com/view/africa-challenged-hepatitis-b-mother-to-child-transmissions}