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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 2018

See all articles by Anna McNaughton

Anna McNaughton

University of Oxford - Nuffield Department of Medicine

José Lourenço

University of Oxford - Department of Zoology

Phillip Armand Bester

University of the Free State

Jolynne Mokaya

University of Oxford

Sheila F. Lumley

University of Oxford - Nuffield Department of Medicine

Donall Forde

Cardiff and Vale University Health Board - Public Health Wales Microbiology Cardiff

Tongai G. Maponga

Stellenbosch University

Kenneth R. Katumba

Government of Uganda - Uganda Virus Research Institute (UVRI)

Dominique Goedhals

University of the Free State

Sunetra Gupta

University of Oxford - Department of Zoology

Janet Seeley

MRC/UVRI and LSHTM Research Unit

Robert Newton

MRC/UVRI and LSHTM Uganda Research Unit

Ponsiano Ocama

Makerere University

Philippa C. Matthews

University of Oxford - Nuffield Department of Medicine; Government of the United Kingdom - Department of Infectious Diseases and Microbiology

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Abstract

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

McNaughton, Anna and Lourenço, José and Bester, Phillip Armand and Mokaya, Jolynne and Lumley, Sheila F. and Forde, Donall and Maponga, Tongai G. and Katumba, Kenneth R. and Goedhals, Dominique and Gupta, Sunetra and Seeley, Janet and Newton, Robert and Ocama, Ponsiano and Matthews, Philippa C., Application of Sero-Epidemiology Data to Inform Interventions for HBV in Africa: Should Diagnosis and Treatment Replace Catch-Up Vaccination? (February 10, 2018). Available at SSRN: https://ssrn.com/abstract=3260787 or http://dx.doi.org/10.2139/ssrn.3260787

Anna McNaughton

University of Oxford - Nuffield Department of Medicine ( email )

Old Road Campus
Roosevelt Drive
Oxford, OX3 7FZ
United Kingdom

José Lourenço

University of Oxford - Department of Zoology ( email )

New Radcliffe House
Radcliffe Observatory Quarter
Oxford, OX13 5QL
United Kingdom

Phillip Armand Bester

University of the Free State ( email )

205 Nelson Mandela Drive
Park West
Bloemfontein, Free State 9300
South Africa

Jolynne Mokaya

University of Oxford

Oxford
United Kingdom

Sheila F. Lumley

University of Oxford - Nuffield Department of Medicine

Old Road Campus
Roosevelt Drive
Oxford, OX3 7FZ
United Kingdom

Donall Forde

Cardiff and Vale University Health Board - Public Health Wales Microbiology Cardiff ( email )

Cardiff
United Kingdom

Tongai G. Maponga

Stellenbosch University

Stellenbosch, Western Cape
South Africa

Kenneth R. Katumba

Government of Uganda - Uganda Virus Research Institute (UVRI)

Uganda

Dominique Goedhals

University of the Free State

205 Nelson Mandela Drive
Park West
Bloemfontein, Free State 9300
South Africa

Sunetra Gupta

University of Oxford - Department of Zoology ( email )

New Radcliffe House
Radcliffe Observatory Quarter
Oxford, OX13 5QL
United Kingdom

Janet Seeley

MRC/UVRI and LSHTM Research Unit

Uganda

Robert Newton

MRC/UVRI and LSHTM Uganda Research Unit

Uganda

Ponsiano Ocama

Makerere University ( email )

P.O Box 7062
P.O BOX 7062
Kampala, CENTRAL 256
Uganda

Philippa C. Matthews (Contact Author)

University of Oxford - Nuffield Department of Medicine ( email )

Old Road Campus
Roosevelt Drive
Oxford, OX3 7FZ
United Kingdom

Government of the United Kingdom - Department of Infectious Diseases and Microbiology ( email )

United Kingdom

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