A changing landscape: Tracking and analysis of the international HDV epidemiology 1999–2020

Abstract

The international epidemiology of Hepatitis Delta Virus (HDV) is challenging to accurately estimate due to limited active surveillance for this rare infectious disease. Prior HDV epidemiological studies have relied on meta-analysis of aggregated and static datasets. These limitations restrict the capacity to actively detect low-level and/or geographically dispersed changes in the incidence of HDV diagnoses. This study was designed to provide a resource to track and analyze the international HDV epidemiology. Datasets analyzed collectively consisted of >700,000 HBV and >9,000 HDV reported cases ranging between 1999–2020. Datasets mined from government publications were identified for Argentina, Australia, Austria, Brazil, Bulgaria, Canada, Finland, Germany, Macao, Netherlands, New Zealand, Norway, Sweden, Taiwan, Thailand, United Kingdom, and United States. Time series analyses, including Mann-Kendall (MK) trend test, Bayesian Information Criterion (BIC), and hierarchal clustering, were performed to characterize trends in the HDV timelines. An aggregated prevalence of 2,560 HDV/HBV100,000 cases (95% CI 180–4940) or 2.56% HDV/HBV cases was identified, ranging from 0.26% in Canada to 20% in the United States. Structural breaks in the timeline of HDV incidence were identified in 2002, 2012, and 2017, with a significant increase occurring between 2013–2017. Significant increasing trends in reported HDV and HBV cases were observed in 47% and 24% of datasets, respectively. Analyses of the HDV incidence timeline identified four distinct temporal clusters, including Cluster I (Macao, Taiwan), Cluster II (Argentina, Brazil, Germany, Thailand), Cluster III (Bulgaria, Netherlands, New Zealand, United Kingdom, United States) and Cluster IV (Australia, Austria, Canada, Finland, Norway, Sweden). Tracking of HDV and HBV cases on an international scale is essential in defining the global impact of viral hepatitis. Significant disruptions of HDV and HBV epidemiology have been identified. Increased surveillance of HDV is warranted to further define the etiology of the recent breakpoints in the international HDV incidence.

Hepatitis Delta Virus Reporting Requirements in the United States and Territories: A Systematic Review

“…This study underscores the need for clearer guidelines on HDV testing and reporting across the United States and territories. With only 55% of states and territories requiring the reporting of HDV-positive test results and the noted changes in HDV epidemiology [ 10 , 11 ], it is crucial that an HDV case definition be developed to support consistent testing and improved tracking of HDV epidemiology. Furthermore, this approach would assist the CSTE in evaluating whether to recommend the inclusion of HDV in the CDC list of notifiable infectious diseases.…”

“…Other studies on HDV epidemiology in the United States have echoed the limited testing of HDV in the HBV patient population [ 7 , 12 ]. Fallon et al evaluated international HDV epidemiology and reported significant structural breaks of unknown origin in HDV epidemiology [ 11 ]. These studies emphasize the need for increased surveillance of HDV.…”

Hepatitis Delta Virus Reporting Requirements in the United States and Territories: A Systematic Review

“…Other studies of HDV epidemiology in the United States have echoed the limited testing of HDV in the HBV patient population 7,10 . Fallon et al evaluated international HDV epidemiology and reported significant structural breaks of unknown origin in HDV epidemiology 11 . These studies emphasize the need for increased surveillance of HDV.…”

No Hepatitis Delta Virus Seropositivity among Blood Donors with Overt and Occult Hepatitis B Infection in Dalian, Liaoning Province, China

“…Recently, HDV infection has received renewed attention worldwide, likely due to the WHO’s global viral hepatitis strategy, which aims to reduce new hepatitis infections by 90% by 2030, and the recent development of HDV-specific antiviral treatments [ 8 , 10 ]. Nevertheless, the regional, national, and global epidemiology of HDV remains poorly documented, although recent reports have suggested changing patterns [ 13 , 23 ]. Differences between selective and non-representative study populations, the often-limited number of samples included in studies, and the limited availability and standardization of the anti-HDV and HDV-RNA tests used can lead to major discrepancies in data that contribute to the global uncertainty around HDV prevalence [ 13 ].…”