Hepatitis B Dosing Programs A Challenge in Europe

Nino Khetsuriani, MD, PhD

The push in recent years to manage and control the spread of hepatitis B virus (HBV) infections in Europe is slowly paying dividends.

However, many countries in Europe hope to improve HBV coverage, increase screenings for pregnant women, and conduct more hepatitis B seroprevalence assessments to help achieve HBV control targets.

According to a new report released by the US Centers for Disease Control and Prevention (CDC) of the 53 countries part of the European Region (EUR), 35, 19, and 17 met coverage targets for 3 doses of hepatitis B vaccine, the birth dose, and for hepatitis B screening of pregnant women, respectively, while Italy and the Netherlands have achieved hepatitis B control.

A team, led by Nino Khetsuriani, MD, PhD, Global Immunization Division, Center for Global Health, CDC, examined the progress in the last 5 years of European countries in general in HBV infection control.

The World Health Organization (WHO) estimates 14 million individuals in Europe were chronically infected with HBV in 2019, with approximately 43,000 individuals dying because of complications related to the chronic infection.

The Target

In 2016, the WHO Regional Office for Europe set hepatitis B control program targets for 2020 including at least 90% coverage with 3 doses of hepatitis B vaccine, at least 90% coverage with interventions to prevent mother-to-child transmission (MTCT) of HBV, and at most 0.5% prevalence of HBV surface antigen (HBsAg) in age groups eligible for vaccination with hepatitis B vaccine.

An example of progress toward this goal can be found in doses for young children as by the end of 2019, 94% (n = 50) offered routine vaccination to Hepatitis B for all children 1-12 years old. This includes 23 (43%) countries that offer HBV vaccination to all newborns.

Also, 73% (n = 35) of countries with universal infant HepB vaccination reached 90% hepatitis 3 dose coverage annually between 2017-2019 and 83% (n = 19) with universal birth dose administration achieved at least 90% timely birth dose coverage annually during the same period.

For counties that provide birth doses to infants born to mothers with positive HBsAg test results, 57% (n = 17) reached antenatal hepatitis B screening coverage of at least 90%.

Reccomendations

While the numbers are improving, there are some reccomendations that could help countries reach their target goals for HBV coverage.

“Countries can accelerate progress toward hepatitis B control by improving coverage with HepB and interventions to prevent MTCT and documenting achievement of the HBsAg seroprevalence target through representative serosurveys or, in low-endemicity countries, antenatal screening,” the authors wrote.

The investigators also promote serosurveys in an effort to fully understand the prevalence and spread of HBV.

“To accelerate validating achievement of the regional hepatitis B control target in EUR, some countries could consider submitting available documentation for validation, whereas others still need to generate the evidence required for validation,” the authors wrote. “Although conducting nationally representative hepatitis B serosurveys might be challenging, and because the COVID-19 pandemic has further challenged their implementation, hepatitis B testing can be incorporated into other nationally representative serosurveys, including COVID-19 serosurveys, where feasible.”