Hepatitis B Elimination Goal May Be Unrealistic for 2030

Devin Razavi-Shearer

Credit: LinkedIn

Targets for eliminating hepatitis B virus (HBV) globally by 2030 are currently unrealistic for a number of countries impacted by the chronic viral disease. New data from the multinational non-profit Polaris Observatory Collaborators show fewer than 1 in 10 patients eligible for HBV treatment across 170 countries actually received treatment.¹

The findings lend credence to public health discourse surrounding the shortcomings of current HBV mitigation and elimination models adopted by particularly affected countries—and highlight the need to bolster diagnosis and treatment strategies against HBV globally.

The Polaris Observatory Collaborators team, led by Devin Razavi-Shearer, associate director of hepatitis B and Delta projects at the CDA Foundation, sought to provide an estimate of national, regional and global HBV prevalence among the general population, as well as pertinent rates of diagnosis, treatment, prevention and projected burden of HBV across the globe.

As previously alluded to, the 2016 World Health Assembly endorsed a public health initiative to eliminate HBV infection as a global health threat by 2030, on the basis of available treatments such as antivirals and prophylaxes making “such elimination feasible, even in the absence of a virological cure.”

Razavi-Shearer and colleagues used a Delphi process with literature review and interview data to conduct their modelling study of HBV infection prevalence, diagnosis, treatment and preventive strategies. Relevant interview data was derived from conversations with national health experts.

The team additionally used a dynamic Markov model to provide estimates on national, regional and global prevalence of HBV infections in 2022, as well as the impact of treatment and prevention on overall disease burden. Investigators further estimated future incidence of morbidity and mortality in the absence of additional options for intervention.

Their final model included 170 countries. The estimated global total was 275.5 million individuals positive with HBsAg (95% CI, 216.6 – 316.4), equating to a global HBV prevalence of 3.2% (95% CI, 2.7 – 4.0).

Of the estimated patient population, just 36.0 million (13.1%) were diagnosed with HBV. Only 6.8 million of the estimated 83.3 million eligible for antiviral treatment were receiving such care (8.2%).

HBV was estimated to affect 5.6 million children worldwide (95% CI, 4.5 -7.8)—a global prevalence of 0.7% (95% CI, 0.6 – 1.0). The most recently available data estimated that while 85% of infants received the recommended 3-dose HBV vaccination before their first birthday, less than half (46%) received a timely birth-dose HBV vaccine.

Another 14% of infants received hepatitis B immunoglobulin along with the full vaccination regimen, and only 3% of mothers with a high viral load for the disease received antiviral treatment to reduce the risk of mother-to-child transmission.

These latest global estimate data align with recent regional reports from areas with higher prevalence of HBV including Africa, where investigators from the Centers for Disease Control and Prevention (CDC) reported that only one-third of the continent’s countries achieved ≥90% rates of 3-dose HBV vaccine coverage for infants in 2021.²

“Scaling up the introduction (birth-dose HBV vaccination) and strategies to increase timely (birth-dose HBV vaccination) and (3-dose HBV vaccination) coverage would accelerate the reduction of preventable hepatitis B–associated morbidity and mortality and progress toward 2030 hepatitis B elimination goals,” the CDC team wrote at the time.

Razavi-Shearer and colleagues concluded similarly that mitigative and preventive measures must be bolstered in the public health pursuit of HBV threat elimination.

“As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks,” they wrote. “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.”

References

1. ^{Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study [published online ahead of print, 2023 Jul 27]. Lancet Gastroenterol Hepatol. 2023;S2468-1253(23)00197-8. doi:10.1016/S2468-1253(23)00197-8}
2. ^{Kunzmann K. Africa Challenged by Hepatitis B Mother-to-Child Transmissions. HCPLive. Published July 21, 2023. https://www.hcplive.com/view/africa-challenged-hepatitis-b-mother-to-child-transmissions}