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Requirements for global elimination of hepatitis B: a modelling study

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Title: Requirements for global elimination of hepatitis B: a modelling study
Authors: Nayagam, S
Thursz, M
Sicuri, E
Conteh, L
Wiktor, S
Low-Beer, D
Hallett, TB
Item Type: Journal Article
Abstract: Background Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them. Methods We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic. Findings Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed. Interpretation Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide 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.
Issue Date: 13-Sep-2016
Date of Acceptance: 16-Jun-2016
URI: http://hdl.handle.net/10044/1/34293
DOI: 10.1016/S1473-3099(16)30204-3
ISSN: 1473-3099
Publisher: Elsevier: Lancet
Start Page: 1399
End Page: 1408
Journal / Book Title: Lancet Infectious Diseases
Volume: 16
Issue: 12
Copyright Statement: © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
National Institute for Health Research
Funder's Grant Number: MR/L002086/1
MR/K010174/1B
HPRU-2012-10080
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
TO-CHILD TRANSMISSION
E-ANTIGEN
MATHEMATICAL-MODEL
NEWBORN-INFANTS
VIRUS INFECTION
IMMUNIZATION
PREVENTION
STRATEGIES
MOTHERS
VACCINE
Antiviral Agents
Global Health
Health Services Accessibility
Hepatitis B
Hepatitis B Vaccines
Humans
Immunization Programs
Infant
Infant, Newborn
Mass Screening
Models, Statistical
Prevalence
Vaccination
Humans
Hepatitis B
Hepatitis B Vaccines
Antiviral Agents
Mass Screening
Vaccination
Prevalence
Models, Statistical
Infant
Infant, Newborn
Immunization Programs
Health Services Accessibility
Global Health
Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
1117 Public Health and Health Services
Publication Status: Published
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine
School of Public Health