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Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi

Stockdale, Alexander J, Meiring, James E, Shawa, Isaac T, Thindwa, Deus, Silungwe, Niza M, Mbewe, Maurice, Kachala, Rabson, Kreuels, Benno, Patel, Pratiksha, Patel, Priyanka, Henrion, Marc, Bar-Zeev, Naor, Swarthout, Todd D, Heyderman, Robert S, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Geretti, Anna Maria and Gordon, Melita A (2021) 'Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi'. The Journal of infectious diseases. (In Press)

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Abstract

BACKGROUND
Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.
METHODS
We conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, 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 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (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.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 536 Human viral hepatitis
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1093/infdis/jiab562
Depositing User: Julie Franco
Date Deposited: 30 Nov 2021 15:52
Last Modified: 05 May 2022 13:50
URI: https://archive.lstmed.ac.uk/id/eprint/19545

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