Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi

Journal article


Stockdale, A.J, Meiring, J.E, Shawa, I., Thindwa, D, Silungwe, N.M, Mbewe, M, Kachala, R, Kreuels, B, Patel, P, Patel, P, Henrion, M.Y.R, Bar-Zeev, N, Swarthout, T.D, Heyderman, R.S, Gordon, S.B, Geretti, A.M and Gordon, M.A 2022. Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi . The Journal of Infectious Diseases. 226 (5), p. 871–880. https://doi.org/10.1093/infdis/jiab562
AuthorsStockdale, A.J, Meiring, J.E, Shawa, I., Thindwa, D, Silungwe, N.M, Mbewe, M, Kachala, R, Kreuels, B, Patel, P, Patel, P, Henrion, M.Y.R, Bar-Zeev, N, Swarthout, T.D, Heyderman, R.S, Gordon, S.B, Geretti, A.M and Gordon, M.A
Abstract

Background
Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce mortality, antiviral treatment programs are needed. We estimated prevalence, vaccine impact, and need for antiviral treatment in Blantyre, Malawi.

Methods
We conducted a household study in 2016–2018. We selected individuals from a census using random sampling and estimated age-sex-standardized hepatitis B surface antigen (HBsAg) seroprevalence. Impact of infant hepatitis B vaccination was estimated by binomial log-linear regression comparing individuals born before and after vaccine implementation. In HBsAg-positive adults, eligibility for antiviral therapy was assessed.

Results
Of 97386 censused individuals, 6073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% confidence interval [CI], 4.3%–6.1%) among adults and 0.3% (95% CI, .1%–.6%) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (95% CI, 70.3%–99.4%). Of HBsAg-positive adults, 26% were HIV-positive. Among HIV-negative individuals, 3%, 6%, and 9% were eligible for hepatitis B treatment by WHO, European, and American hepatology association criteria, respectively.

Conclusions
Infant HBV vaccination has been highly effective in reducing HBsAg prevalence in urban Malawi. Up to 9% of HBsAg-positive HIV-negative adults are eligible, but have an unmet need, for antiviral therapy.

Keywordshepatitis B; vaccination; epidemiology; antiviral agents; Malawi; Africa; south of the Sahara; public health
Year2022
JournalThe Journal of Infectious Diseases
Journal citation226 (5), p. 871–880
PublisherOxford University Press
ISSN 1537-6613
Digital Object Identifier (DOI)https://doi.org/10.1093/infdis/jiab562
Web address (URL)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470106/
https://academic.oup.com/jid/article/226/5/871/6424415
Output statusPublished
Publication dates
Online01 Sep 2022
Publication process dates
Deposited06 Jun 2023
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