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

Publicated to:Lancet Gastroenterology & Hepatology. 8 (10): 879-907 - 2023-01-01 8(10), DOI: 10.1016/S2468-1253(23)00197-8

Authors: Razavi-Shearer DM; Gamkrelidze I; Pan CQ; Jia J; Berg T; Gray RT; Lim Y-S; Chen C-J; Ocama P; Desalegn H; Abbas Z; Abdallah AR; Aghemo A; Ahmadbekova S; Ahn SH; Aho I; Akarca US; Al Masri NM; Alalwan AM; Alavian SM; Al-Busafi SA; Aleman S; Alfaleh FZ; Alghamdi AS; Al-Hamoudi WK; Aljumah AA; Al-Naamani K; Al-Rifai A; AlSerkal YM; Altraif IH; Amarsanaa J; Anderson M; Andersson MI; Armstrong P; Asselah T; Athanasakis K; Baatarkhuu O; Ben-Ari Z; Bensalem A; Bessone F; Biondi MJ; Bizri ARN; Blach S; Braga WSM; Brandão-Mello CE; Brosgart CL; Brown KA; Brown RS; Jr; Bruggmann P; Brunetto MR; Buti M; Cabezas J; Casanovas T; Chae C; Chan HLY; Cheinquer H; Chen P-J; Cheng KJG; Cheon M-E; Chien C-H; Choudhuri G; Christensen PB; Chuang W-L; Chulanov V; Cisneros Garza LE; Coffin CS; Contreras FA; Coppola N; Cornberg M; Cowie B; Cramp ME; Craxi A; Crespo J; Cui F; Cunningham CW; Dalgard O; De Knegt RJ; De Ledinghen V; Dore GJ; Drazilova S; Duberg A-S; Egeonu S; Elbadri M; El-Kassas M; El-Sayed MH; Estes C; Etzion O; Farag E; Ferradini L; Ferreira PRA; Flisiak R; Forns X; Frankova S; Fung J; Gane EJ; Garcia V; Garcia-Samaniego J; Gemilyan M; Genov J; Gheorghe LS; Gholam PM; Gish RG; Goleij P; Gottfredsson M; Grebely J; Gschwantler M; Guingane NA; Hajarizadeh B; Hamid SS; Hamoudi W; Harris AM; Hasan I; Hatzakis A; Hellard ME; Hercun J; Hernandez J; Hockicková I; Hsu Y-C; Hu C-C; Husa P; Janicko M; Janjua N; Jarčuška P; Jaroszewicz J; Jelev D; Jeruma A; Johannessen A; Kåberg M; Kaita KDE; Kaliaskarova KS; Kao J-H; Kelly-Hanku A; Khamis F; Khan AG; Kheir OO; Khoudri I; Kondili LA; Konysbekova A; Kristian P; Kwon JA; Lagging M; Laleman W; Lampertico P; Lavanchy D; Lázaro P; Lazarus JV; Lee AU; Lee M-H; Liakina V; Lukšić B; Malekzadeh R; Malu AO; Marinho RT; Mendes-Correa MC; Merat S; Meshesha BR; Midgard H; Mohamed R; Mokhbat JE; Mooneyhan E; Moreno C; Mortgat L; Mullhaupt B; Musabaev E; Muyldermans G; Naveira MCM; Negro F; Nersesov AV; Nguyen VTT; Ning Q; Njouom R; Ntagirabiri R; Nurmatov ZS; Oguche S; Omuemu CE; Ong JP; Opare-Sem OK; Ormeci N; Orrego M; Osiowy C; Papatheodoridis GV; Peck-Radosavljevic M; Pessoa MG; Pham TND; Phillips RO; Pimenov N; Pincay-Rodriguez LDR; Plaseska-Karanfilska D; Pop C; Poustchi H; Prabdial-Sing NN; Qureshi H; Ramji A; Rautiainen H; Razavi-Shearer K; Remak WM; Ribeiro S; Ridruejo E; Ríos-Hincapié CY; Robalino MC; Roberts LR; Roberts SK; Rodríguez M; Roulot D; Rwegasha J; Ryder SD; Sadirova S; Saeed U; Safadi R; Sagalova O; Said SS; Salupere R; Sanai FM; Sanchez-Avila JF; Saraswat VA; Sargsyants N; Sarrazin C; Sarybayeva G; Schréter I; Seguin-Devaux C; Seto W-K; Shah SR; Sharara AI; Sheikh M; Shouval D; Sievert W; Simojoki K; Simonova MY; Sinn DH; Sonderup MW; Sonneveld MJ; Spearman CW; Sperl J; Stauber RE; Stedman CAM; Sypsa V; Tacke F; Tan S-S; Tanaka J; Tergast TL; Terrault NA; Thompson AJ; Thompson PJ; Tolmane I; Tomasiewicz K; Tsang T-Y; Uzochukwu BSC; Van Welzen B; Vanwolleghem T; Vince A; Voeller AS; Waheed Y; Waked I; Wallace J; Wang C; Weis N; Wong GL-H; Wong VW-S; Wu J-C; Yaghi CG; Yesmembetov K; Yip TC-F; Yosry A; Yu M-L; Yuen M-F; Yurdaydin C; Zeuzem S; Zuckerman E; Razavi HA

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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 3·2% (95% uncertainty interval 2·7–4·0), corresponding to 257·5 million (216·6–316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6–1·0), corresponding to 5·6 million (4·5–7·8) 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. Interpretation: As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. Funding: John C Martin Foundation, Gilead Sciences, and EndHep2030. © 2023 Elsevier Ltd

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