Hepatitis B Virus (HBV) Bridges Gap Between Policy and Implementation in Vaccine Coverage

Danjuma Adda, MPH, FIMS, Dip-IMS, is the past president of the World Hepatitis Alliance and a fellow with the Aspen Voices Fellowship. He is the founder of Appreciate You Organization in Nigeria, which works to improve access to hepatitis testing and increase awareness about the disease. Ida is also living with HBV.

Chronic HBV infection remains a significant global health challenge, leading to approximately 1.1 million deaths in 2022, primarily from cirrhosis and hepatocellular carcinoma, according to WHO. In 2022, an estimated 254 million people worldwide were living with HBV, with the highest prevalence in the African and Western Pacific regions, where 65% of these cases are found.

“There has not been any significant improvement in the diagnosis and treatment of hepatitis B. The prevalence of hepatitis B is alarming, with the disease claiming over 270,000 lives annually in Africa. The rate of diagnosis is dire; only about 3% of hepatitis cases are diagnosed, and merely 2% of those diagnosed receive treatment.”

The primary transmission routes of HBV are from mother to child at birth and through horizontal household contact. Despite the severity of the disease, there has been notable progress in preventing perinatal HBV transmission through universal infant vaccination programs. The administration of a hepatitis B vaccine within 24 hours of birth has been shown to be 90-95% effective in preventing the infection and has significantly reduced the incidence among children. However, global coverage of this birth-dose vaccination is still low at 45%, and even lower in the WHO African region at 18%.

“The WHO recommends that newborns should receive the HBV vaccine within 24 hours of birth, or as early as possible. This is a critical measure to prevent new infections and it's important to remember that this is a cancer-preventing vaccine. To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. It's crucial that the vaccines are accessible exactly where and when the babies are born.”

For those already living with HBV, treatments such as tenofovir or entecavir have been highly effective in slowing the progression of liver disease and reducing the incidence of liver cancer, improving long-term survival rates. A substantial gap in diagnosis and treatment persists only 13% of those with HBV were diagnosed in 2022, and a mere 3% received treatment.

“To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. It's crucial that the vaccines are accessible exactly where and when the babies are born.”

Achieving the WHO's elimination goals, which aim for 90% testing coverage and 80% treatment coverage, will require a significant overhaul of the current approaches to diagnosing and treating HBV. This includes simplifying treatment criteria, diagnostic methods, and care pathways to enhance access to vital testing and treatment services.

Reference

Easterbrook P, Luhmann N, Bajis, et. al. WHO 2024 Hepatitis B Guidelines: An Opportunity to Transform Care. Lancet. Published April 10, 2024. Accessed April 12, 2024. DOI: https://doi.org/10.1016/S2468-1253(24)00089-X