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

The Polaris Observatory Collaborators

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)383-403
Number of pages21
JournalThe Lancet Gastroenterology and Hepatology
Volume3
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

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Virus Diseases
Hepatitis B virus
Vaccination
Hepatitis B Surface Antigens
Mothers
Therapeutics
Antiviral Agents
Infection
Viral Load
Hepatitis B
PubMed
Hepatitis
Population
Uncertainty
Immunoglobulins
Epidemiology
Parturition
Interviews

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016 : a modelling study. / The Polaris Observatory Collaborators.

In: The Lancet Gastroenterology and Hepatology, Vol. 3, No. 6, 01.06.2018, p. 383-403.

Research output: Contribution to journalArticle

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abstract = "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.",
author = "{The Polaris Observatory Collaborators} and Devin Razavi-Shearer and Ivane Gamkrelidze and Nguyen, {Mindie H.} and Chen, {Ding Shinn} and {Van Damme}, Pierre and Zaigham Abbas and Maheeba Abdulla and {Abou Rached}, Antoine and Danjuma Adda and Inka Aho and Ulus Akarca and Fuad Hasan and {Al Lawati}, Faryal and {Al Naamani}, Khalid and Al-Ashgar, {Hamad Ibrahim} and Alavian, {Seyed M.} and Sameer Alawadhi and Agustin Albillos and Al-Busafi, {Said A.} and Soo Aleman and Alfaleh, {Faleh Z.} and Aljumah, {Abdulrahman A.} and Anand, {Anil C.} and Anh, {Nguyen Thu} and Arends, {Joop E.} and Perttu Arkkila and Kostas Athanasakis and Abate Bane and Ziv Ben-Ari and Thomas Berg and Bizri, {Abdul R.} and Sarah Blach and {Brand{\~a}o Mello}, {Carlos E.} and Brandon, {Samantha M.} and Bisi Bright and Philip Bruggmann and Maurizia Brunetto and Maria Buti and Chan, {Henry L.Y.} and Asad Chaudhry and Chien, {Rong Nan} and Choi, {Moon S.} and Christensen, {Peer B.} and Chuang, {Wan Long} and Vladimir Chulanov and Clausen, {Mette R.} and Massimo Colombo and Markus Cornberg and Benjamin Cowie and Antonio Craxi",
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TY - JOUR

T1 - Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016

T2 - a modelling study

AU - The Polaris Observatory Collaborators

AU - Razavi-Shearer, Devin

AU - Gamkrelidze, Ivane

AU - Nguyen, Mindie H.

AU - Chen, Ding Shinn

AU - Van Damme, Pierre

AU - Abbas, Zaigham

AU - Abdulla, Maheeba

AU - Abou Rached, Antoine

AU - Adda, Danjuma

AU - Aho, Inka

AU - Akarca, Ulus

AU - Hasan, Fuad

AU - Al Lawati, Faryal

AU - Al Naamani, Khalid

AU - Al-Ashgar, Hamad Ibrahim

AU - Alavian, Seyed M.

AU - Alawadhi, Sameer

AU - Albillos, Agustin

AU - Al-Busafi, Said A.

AU - Aleman, Soo

AU - Alfaleh, Faleh Z.

AU - Aljumah, Abdulrahman A.

AU - Anand, Anil C.

AU - Anh, Nguyen Thu

AU - Arends, Joop E.

AU - Arkkila, Perttu

AU - Athanasakis, Kostas

AU - Bane, Abate

AU - Ben-Ari, Ziv

AU - Berg, Thomas

AU - Bizri, Abdul R.

AU - Blach, Sarah

AU - Brandão Mello, Carlos E.

AU - Brandon, Samantha M.

AU - Bright, Bisi

AU - Bruggmann, Philip

AU - Brunetto, Maurizia

AU - Buti, Maria

AU - Chan, Henry L.Y.

AU - Chaudhry, Asad

AU - Chien, Rong Nan

AU - Choi, Moon S.

AU - Christensen, Peer B.

AU - Chuang, Wan Long

AU - Chulanov, Vladimir

AU - Clausen, Mette R.

AU - Colombo, Massimo

AU - Cornberg, Markus

AU - Cowie, Benjamin

AU - Craxi, Antonio

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

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