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Experts say scaling-up interventions may eliminate HBV as global threat
Although effective prevention and treatment interventions exist for hepatitis B virus infection, they are not always used or available, according to research published in The Lancet Infectious Disease.
These study results showed key ways to eliminate the infection burden — the scale-up of current interventions and implementation of population-wide testing and treatment — are needed and achievable.
“The current global approach to tackle HBV — a reliance on infant vaccination — has brought enormous health gains, but a step-change in strategy will be needed to bring a target of HBV elimination within reach,” Shevanthi Nayagam, MD, division of digestive diseases, St. Mary’s Hospital, Imperial College London, and colleagues wrote. “This change must see a large increase in the proportion of births that benefit from a package of prevention interventions and in the proportion of people with chronic HBV carriage who are diagnosed and treated when eligible, as well as maintenance and expansion of infant vaccination programs.”
Current interventions — infant vaccination and antiviral therapy — are not fully used in all countries, according to the researchers. For example, in Central Africa, only 56% of infants were vaccinated in 2013 compared with East and North Africa and the Middle East (92%-96%).
To expand current public health interventions and determine any impact of these interventions and identifying developments required to achieve them, the researchers created a simulation model of the current global HBV epidemic. They used data on the natural history of HBV, prevalence, mortality, vaccination, treatment dynamics and demographics. Next they estimated the impact of current interventions and the scaling up of the existing interventions for prevention of infection. In addition, they estimated the benefits of introducing wide-scale population screening and treatment interventions worldwide.
Currently, vaccinating infants for HBV has decreased the incidence of new infections and prevented 210 million new chronic infections by 2015. This will lead to a decrease in mortality by 1.1 million deaths by 2030, the researchers wrote. However, without the scale-up of existing interventions, the model showed that 63 million new cases of chronic infection and 17 million HBV-related deaths will occur between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people who already have HBV.
A 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up infant vaccination (to 90% in infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of mothers who are positive for hepatitis B e antigen) and populationwide testing and treatment (to 80% of patients eligible).
“These interventions would avert 7.3 million deaths between 2015 and 2030, including 1.5 million cases of cancer deaths,” the researchers wrote. “An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide.”
The model also showed the annual cost would peak at $7.5 billion worldwide and $3.4 billion in low-income and lower-middle-income countries. However, this would decrease rapidly and could be accelerated if a cure is developed, according to the researchers.
While knowing strategies and their effectiveness is important, Grace Lai-Hung Wong, MD, and Vincent Wai-Sun Wong, MD, both from the department of medicine and therapeutics at The Chinese University of Hong Kong, said in an editorial that knowing effective strategies is only the first step to eliminating HBV as a global threat.
“The benefits will not materialize if the interventions are not implemented,” they wrote. “Some policies that sound straightforward in the developed world can face major hurdles in low-income and middle-income countries.”
For example, they said, patient management might be difficult, as well as transporting vaccines to remote areas and temperature control and the ability to train health care providers.
Nonetheless, they said WHO’s goal to eradicating viral hepatitis by 2030 can be achieved.
“Achievement of this goal calls for concerted effort from policymakers, clinicians and societies. The tools to combat HBV are already at hand, and now is the time for action.”
Nayagam and colleagues concluded: “Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious populationwide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis.” – by Melinda Stevens
Disclosures: Nayagam reports receiving personal fees from WHO. Please see the full study and the commentary for a list of all other authors’ relevant financial disclosures.