Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992–2015

Abstract

In 2016, the Immunization Technical Advisory Group of the South-East Asia Region (SEAR) endorsed a regional goal to achieve ≤1% prevalence of hepatitis B surface antigen (HBsAg) among 5-year-old children by 2020. Chronic hepatitis B virus (HBV) infection is largely preventable with a birth dose of hepatitis B vaccine (HepB-BD) followed by two to three additional doses. We reviewed the progress towards hepatitis B control through vaccination in SEAR during 1992-2015. We summarized hepatitis B vaccination data and reviewed the literature to determine the prevalence of chronic HBV infection pre- and post-vaccine introduction. We used a mathematical model to determine post-vaccine prevalence of HBsAg among 5 year olds in countries lacking national serosurvey data and estimated the impact of vaccination on disease burden. Regional coverage with three doses of hepatitis B vaccine (HepB3) increased from 56% in 2011 to 87% in 2015. By 2016, 7 of 11 countries had introduced universal HepB-BD. Regional HepB-BD coverage increased from 9% in 2011 to 34% in 2015. In 2015, estimated HBsAg among 5 year olds was 1.1% with variability among countries. Myanmar (3.8%), Timor-Leste (2.7%), Indonesia (1.8%), and India (1%) had the highest prevalence of HBsAg. During 1992-2015, vaccination prevented approximately 16 million chronic HBV infections and 2.6 million related deaths. In 2015, around 197,640 perinatal HBV infections occurred in SEAR with majority occurring in India (62%), Bangladesh (24%), and Myanmar (8%). Myanmar had the highest rate of perinatal chronic HBV infections at 16 per 1000 live births. Despite significant progress in the control of HBV, SEAR needs to secure political commitment for elimination and consider additional strategies, such as promoting health facility births, universal birth dose administration, developing strong coordination between health sectors, and using alternative vaccine delivery methods, to improve HepB-BD coverage and subsequently achieve HBV control and elimination.

Liver Fibrosis: Mechanistic Concepts and Therapeutic Perspectives

“…Despite the presence of an efficient vaccine, chronic HBV infection still affects currently approximately 260 million people, mostly in Africa and Asia [188]. While horizontal transmission of adults often results in self-limiting acute infection, vertical transmission mostly leads to chronic infection [189,190].…”

Using a Hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu Provinces to improve data quality and assess program effectiveness, China, 2015

“…Because health care staff at grade 3 hospitals in China typically have advanced degrees in medicine and research, these ndings could suggest differences in training and clinical awareness. Lack of awareness among health care workers and laboratory staff was also identi ed as a major gap in viral hepatitis case detection and reporting in a survey on HBV and HCV testing and service delivery in low and middle-income countries [28]. Sta ng constraints and doctor-to-patient ratios could also affect the correct case classi cation and reporting [29,30].…”

Endemic hepatitis B virus (HBV) among hospital in-patients in Bangladesh, including evidence of occult infection

“…Interventions include programmes for screening donor blood by testing for hepatitis B surface antigen (HBsAg) 5 , and delivery of universal infant HBV vaccination starting at age six weeks, through the World Health Organization (WHO) Expanded Programme for Immunization (EPI) 8,9 . Estimates suggest that CHB prevalence has declined from 8% to <6% since the vaccine initiative was introduced in Bangladesh in 2003 10,11 , but nevertheless, the perinatal incidence of new infections remains among the highest in South Asia 12 .…”