NEW YORK (Reuters Health) – About 292 million people worldwide may be infected with hepatitis B virus (HBV), a new modeling study shows.
Just 10% have been diagnosed, however, and only 5% of those eligible for treatment are receiving it, according to Dr. Homie Razavi and colleagues from the Center for Disease Analysis Foundation, a research firm in Lafayette, Colorado. The findings appeared online March 26 in The Lancet Gastroenterology & Hepatology.
“One of the key objectives of this analysis is to say look, we have a serious problem,” Dr. Razavi told Reuters Health by phone. “We should have eradicated this a long time ago.”
Previous studies based largely on meta-analyses and reviews had pegged global HBV prevalence at 248 million to 257 individuals, Dr. Razavi and his team note in their report.
HBV is most common in sub-Saharan Africa and Asia, and mother-child transmission is the main source of new infections. While most adults who contract the virus will clear it, most infected children go on to have chronic HBV infection, leading to cirrhosis and liver cancer.
As with HIV, people with chronic infection must take medication for the rest of their lives to keep the infection under control, typically tenofovir and entecavir.
An HBV vaccine became available in 1981, and has been more widely accessible since 2001, when Gavi, the Vaccine Alliance began supporting HBV vaccination programs. In 2015, the World Health Assembly set HBV goals of 90% childhood vaccine coverage, 0.1% prevalence in 5-year-olds and 80% treatment coverage by 2030.
In the new study, the researchers used a Delphi process with a literature review and expert interviews to develop models of HBV surface antigen (HBVsA) prevalence, prophylaxis, diagnosis and treatment in 120 countries.
A total of 291,992,000 people worldwide had HBV infection in 2016, the authors estimate, or about 3.9% of the global population.
The number includes 1.8 million 5-year-olds, for a prevalence of 1.4%. About 29 million, or 10%, of people with HBV had been diagnosed. Among the 94 million eligible for treatment, based on having cirrhosis and a high viral load, only 4.8 million were on antivirals.
About 46% of infants received a birth-dose vaccination within 24 hours, and 89% of children under age one had received all three doses of the HBV vaccine.
Thirteen percent of babies born to HbsAg-positive mothers had received the full prophylactic treatment of timely birth-dose and follow-up vaccination, along with hepatitis B immunoglobulin. The authors estimate that just 1% of mothers with high viral loads had received antiviral treatment.
Currently, Dr. Razavi noted, Gavi does not pay for birth-dose vaccination, so in many countries it is only available to women who can pay out of pocket.
Dr. Geoffrey Dusheiko of Kings Hospital and Royal Free Hospital in London co-authored an editorial accompanying the study. “I think that there’s enough data in this paper to indicate the prevalence is high in a number of regions, and that we should not procrastinate and undertake expensive seroprevalence studies, but that we should start screening” for HBV, he told Reuters Health by phone.
The study “should focus the minds of governments and doctors working in regions of high prevalence, that in order to meet elimination targets we have a long way to go,” he added. “We did quite well with overall universal vaccination, but the rest of the picture is somewhat bleak.”
SOURCE: https://bit.ly/2GO3Byx and https://bit.ly/2q5IJbY
Lancet Gastroenterol Hepatol 2018.
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