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Application of Sero-Epidemiology Data to Inform Interventions for HBV in Africa: Should Diagnosis and Treatment Replace Catch-Up Vaccination?
28 Pages Posted: 7 Oct 2018More...
Background: International goals for hepatitis B virus (HBV) infection set ambitious targets for elimination by 2030. In populations with a high prevalence of infection, catch-up HBV vaccination of adults is sometimes deployed. An alternative approach of 'test and treat' could be applied as a population intervention for HBV.
Methods: We used a systematic approach to determine the relationship between prevalence of HBV infection (HBsAg) and exposure (anti-HBc) in Africa. We applied a mathematical model to compare the impact of catch-up vaccination with a 'test and treat' strategy in a high prevalence setting.
Findings: There is a strong relationship between the prevalence of HBsAg and anti-HBc (p<0·0001) across Africa, but the pattern differs between regions. In settings with high prevalence of infection, catch-up vaccination may have a transient effect. However, this intervention does not contribute to a sustained decline in prevalence, because a high proportion of adults are either already infected or immune as a result of prior exposure. In contrast, diagnosing and treating infection has a marked impact on reducing prevalence, equivalent to that of neonatal vaccination.
Interpretation: We have developed a high-resolution picture of HBV epidemiology across Africa. In combination with robust neonatal vaccination programmes, testing and treating infection is likely to be of more benefit than catch-up vaccination. This alternative not only benefits the infected individual, but also has impact on transmission, thus contributing to sustained reductions in population prevalence.
Funding Statement: Wellcome Trust, grant reference 110110.
Declaration of Interests: The authors state: "We have no conflicts of interest to declare."
Ethics Approval Statement: The authors state: "Ethics approval was not required for this study, as we only analysed data that are already available in the public domain."
Keywords: HBV, vaccination, epidemiology, prevalence, catch-up, booster, elimination, immunization, sustainable development goals, Africa, Uganda
Suggested Citation: Suggested Citation