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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, Vol 226, Issue 5, pp. 871-880.
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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: | 02 Feb 2023 08:52 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/19545 |
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