Only an estimated one in 20 patients with hepatitis B worldwide received antiviral therapy for their illness in 2016.
that less than half of infants received timely birth dose vaccination,
and less than 1% of mothers with a high viral load received antiviral
therapy in 2016.
estimated one in 20 patients with hepatitis B worldwide received
antiviral therapy for their illness in 2016, a modeling study found.
Of the estimated 292 million people living with hepatitis B virus
(HBV), there were 94 million individuals eligible for treatment, but
only 4.8 million (5%) actually received it, reported The Polaris
less than half of infants received timely birth dose vaccination, and
less than 1% of mothers with a high viral load received antiviral
therapy in 2016, the authors wrote in the Lancet Gastroenterology & Hepatology.
Reduction of hepatitis B in infants, via mother-to-child
transmission, was characterized as important by the authors, because
"most HBV infections in infants become chronic, which is the leading
source of new chronic HBV infections." Moreover, they cite the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis, which hopes to eliminate hepatitis B and hepatitis C worldwide by 2030. Targets for hepatitis B include:
90% global coverage of three-dose infant vaccination by 2020
Timely birth dose vaccination in 50% of infants by 2020, and in 90% by 2030
Prevalence in children age 5 years of 1% by 2020, and 0.1% by 2030
Diagnosis of 90% of people infected with HBV by 2030
Antiviral treatment of 80% of those diagnosed and eligible for treatment by 2030
The group cited recent estimates from the Lancet or the WHO,
which estimated 248 million or 257 million individuals with HBV
infection. But the authors added that "these reports were limited by
their calculation of averages using a combination of robust and
representative studies, studies done in different age groups, and
studies done at different time points." They added that these were
historical estimates that did not consider the effects of vaccination
and efforts to prevent perinatal transmission of HBV.
Using a combination of data from prior studies as well as expert
interviews, this group developed models for 120 countries, of which 78
used data approved by experts. They estimated that global prevalence of
hepatitis B surface antigen (HbsAg) was 3.9% (95% uncertainty interval
3.4-4.6) or around 292 million infections (95% UI
251,513,000-341,114,000) in 2016.
However, only 29 million (10%) of the 292 million HbSAg-positive patients were diagnosed in 2016. An accompanying editorial
by Geoffrey Dusheiko, MD, of King's College Hospital in London, and
Kosh Agarwal, MD, of University College London, characterized these
figures as "disconcerting," given that a diagnostic test for hepatitis B
"has long been available."
is a need to raise awareness of HBV to the same level as that of HIV
and a pressing prerequisite for inexpensive, innovative, point-of-care
nucleic acid testing for HBV DNA, paired with hepatitis C virus RNA and
HIV RNA assays," the editorialists wrote. "The incidence of new chronic
HBV infections will continue to increase unless appropriate prevention
at birth is applied, and deaths will increase in unvaccinated adults
unless large increases in screening and linkage to care are
The authors estimated that 1.8 million infections were in children
age 5 years, with a prevalence of 1.4%. They added that while they
estimated only 46% of infants received a timely birth-dose vaccination,
87% of infants younger than 1 year did receive the three-dose HBV
vaccination schedule. Weighting by births of mothers with high viral
loads, the authors found less than 1% received antiviral treatment in
Five countries -- China, India, Nigeria, Indonesia, and the
Philippines -- accounted for more than half of hepatitis B infections
worldwide, and five countries (Nigeria, India, Indonesia and the
Democratic Republic of the Congo) accounted for more than half of
estimated infections in children age 5 years.
Of note, the authors said that of the 16 countries with the greatest
number of infected children, only China had timely-birth dose vaccine
coverage of 90% or higher, while 10 of these countries had not yet
introduced timely birth dose. They added that "these figures show the
importance of robust prophylaxis schedules."
But they also said that the largest strides towards global
elimination of HBV were in infant vaccination, with 94 of the modeled
countries estimated to have met the 2020 target of 1% prevalence among
children age 5, and 46 estimated to have met the 0.1% prevalence target
Study limitations included that while it was available for 90% of the
estimated number of infections globally, some countries where data was
extrapolated had large populations, and some regions had only a few
countries with data. In addition, while national estimates may be
correct, there may be regional variations, as the study did not account
for certain populations with a higher prevalence than the general
population, such as immigrants, indigenous peoples and nations, people
who inject drugs, and sex workers.
This study was supported by the John C. Martin Foundation.
authors disclosed support from the John C. Martin Foundation, Gilead
Sciences, AbbVie, WHO, National Academy of Sciences, Intercept
Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb (BMS),
Janssen, Novartis, Anylam, Dynavax, Mylan Pharmaceuticals, ViiV
Healthcare, Merck Sharp & Dohme, Roche, Sequana Medical, Bayer,
Vertex, Tibotec, Intercept, Sirtex, Alexion, MedImmune, Intellia, Biogen
Idec, Falk Foundation, Siemens, Perspectum Diagnostics, Quadri Pharma,
New South Wales Ministry of Health, Hologic, GlaxoSmithKline, Aevi
Genomic Medicine, ENYO Pharma, CureVac, Intercept, Sigma-Tau, Celgene,
Lupin, PRA Health Sciences, Regulus, Alnylam, R-Pharm, Replicor, the
government of Ghana, BTG, Ariad, Wako, Medscape, Axis, OncLive, Tavec,
Grail, Hepatera, Marcyrl, Onxio, Pharco, Fujirebio and Biocartis.
and Agarwal disclosed relevant relationships with Gilead Sciences, BMS,
Abbott Laboratories, Janssen, Transgene, Merck, and Vir Biotechnology.