HBV elimination goals set by WHO not attainable, experts say

Current efforts to eradicate hepatitis B virus (HBV), including vaccination, screening, and treatment strategies, do not seem enough to achieve the elimination goals set by the World Health Organization (WHO), suggests a recent study.

“Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable, highlighting the need for a re-evaluation of the global strategy for HBV, the importance of developing curative therapy for HBV, and of establishing tailored strategies to prevent long-term sequelae and improve health in immigrants,” the authors said.

An agent-based model was developed to describe the HBV epidemic in a high-income country with ongoing immigration. HBV spread was simulated through sexual networks and perinatal transmission. The authors estimated model parameters from the literature and calibrated these against historical HBV data. They also carried out sensitivity analyses to evaluate the uncertainty.

Under the current strategies, the authors predicted that the incidence of acute hepatitis B and HBV-attributable decompensated cirrhosis and hepatocellular carcinoma would decrease by 64.5 percent, 9.4 percent, and 10.5 percent, respectively, between 2015 and 2030. The incidence of chronic hepatitis B and liver-related deaths, however, would risk by 26.6 percent and 1.0 percent, respectively.

Of note, these findings were sensitive to the number of immigrants and HBV prevalence in immigrants.

“Our analysis suggests that current vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals of eliminating chronic hepatitis B,” the authors said. “Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable.”