Cost-effectiveness modelling of birth and infant dose vaccination against hepatitis B virus in Ontario from 2020 to 2050

Abstract

In Ontario, hepatitis B virus (HBV) ranks fourth on the list of infectious diseases with the greatest burden of illness by years of life lost, 1 and can lead to cirrhosis and liver failure or hepatocellular carcinoma. Infants who acquire HBV have a more than 90% risk of progression to chronic infection. 2 The World Health Organization (WHO) has prioritized birth dose vaccination for HBV as a key tenet of the strategy for HBV elimination. Vaccination within 24 hours of birth and 2 additional infant doses is more than 90% effective at preventing transmission and has decreased global prevalence from 5% to 1% in children under 5 years of age. 2 However, even after 30 years and adoption among more than 100 countries (including the United States, United Kingdom and Australia), 3 only 3 provinces and territories in Canada provide birth dose vaccination: 5 vaccinate in infancy and 5 in adolescence, including in Ontario. 4 It is hypothesized that the rationale for adolescent vaccination is based on 4 assumptions: all pregnant women are screened, all infants born to mothers who are positive for HBV receive postexposure immunization, sexual contact is the only other risk factor, and immunity from birth and infant vaccination wanes. 5 The National Advisory Committee on Immunization has proposed that each province must monitor for inadequate prenatal screening and preventable pediatric infections. 5 At present, Ontario does not have a centralized database to show that all children born to a mother who is positive for HBV receive birth doses and 2 subsequent doses, in addition to hepatitis B immune Cost-effectiveness modelling of birth and infant dose vaccination against hepatitis B virus in Ontario from 2020 to 2050

Hepatitis B virus genotype surveillance in Canadian blood donors and a referred patient population, 2016–2021

“…A similar finding for firsttime donors was described in France [29]. Although HBV vaccination is universally available to children in Canada, vaccination schedules differ across the country, ranging from an initial birth dose to a twodose schedule at 12-13 years of age [30]. The proportion of genotypes also differed between provinces, likely due to the preferred sites of migration across the country.…”

Comparison of the effectiveness four years after Homo/Hetero prime-boost with 10 μg HP and 20 μg CHO recombinant hepatitis B vaccine at 1 and 6 months in maternal HBsAg-negative children

“…The introduction of hepatitis B vaccination at birth or in infancy prevents pediatric HBV infection and is cost effective or even cost saving ( 14 ). However, the long-term persistence of immunogenicity decreases with increasing age after vaccination ( 15 ).…”

Global Perspectives on the Hepatitis B Vaccination: Challenges, Achievements, and the Road to Elimination by 2030

“…Alternatively, switching from adulthood vaccination to birth dose vaccination proved more cost-effective in Ontario, Canada. Moreover, incorporating the HBV vaccine into a hexavalent vaccine would save approximately USD 428,000 per disability-adjusted life year [ 109 ]. This lack of consensus necessitates further investigation to tailor policy recommendations to specific low-endemicity contexts.…”