A mathematical model to estimate global hepatitis B disease burden and vaccination impact

TLDR

Global hepatitis B virus (HBV) morbidity and mortality are poorly quantified, limiting understanding of the disease burden and the potential impact of vaccination. The study aims to estimate the global HBV disease burden and the impact of vaccination on reducing morbidity and mortality. A mathematical model was constructed to compute age‑specific HBV infection risk, acute and chronic disease outcomes, and to estimate vaccination effects based on efficacy, coverage, and birth‑dose administration. The model estimated 620,000 HBV‑related deaths in 2000, with 84 % preventable by a birth‑dose vaccination program, and found that most deaths arise from chronic sequelae of perinatal and early childhood infection.

Abstract

Limited data are available regarding global hepatitis B virus (HBV)-related morbidity and mortality and potential reduction in disease burden from hepatitis B vaccination.A model was developed to calculate the age-specific risk of acquiring HBV infection, acute hepatitis B (illness and death), and progression to chronic HBV infection. HBV-related deaths among chronically infected persons were determined from HBV-related cirrhosis and hepatocellular carcinoma (HCC) mortality curves, adjusted for background mortality. The effect of hepatitis B vaccination was calculated from vaccine efficacy and vaccination series coverage, with and without administration of the first dose of vaccine within 24 h of birth (i.e. birth dose) to prevent perinatal HBV infection.For the year 2000, the model estimated 620,000 persons died worldwide from HBV-related causes: 580,000 (94%) from chronic infection-related cirrhosis and HCC and 40,000 (6%) from acute hepatitis B. In the surviving birth cohort for the year 2000, the model estimated that without vaccination, 64.8 million would become HBV-infected and 1.4 million would die from HBV-related disease. Infections acquired during the perinatal period, in early childhood (<5 years old), and > or = 5 years of age accounted for 21, 48, and 31% of deaths, respectively. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths.Globally, most HBV-related deaths result from the chronic sequelae of infection acquired in the perinatal and early childhood periods. Inclusion of hepatitis B vaccine into national infant immunization programs could prevent >80% of HBV-related deaths.