Requirements for global elimination of hepatitis B: a modelling study

Nayagam, Shevanthi; Thursz, Mark; Sicuri, Elisa; Conteh, Lesong; Wiktor, Stefan Z.; Low‐Beer, Daniel; Hallett, Timothy B.

doi:10.1016/s1473-3099(16)30204-3

Cited by 319 publications

(295 citation statements)

References 35 publications

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“…However, it remains controversial whether and when to administrate the antiviral prophylaxis during pregnancy. NAs were not recommended for pregnant women, possibly because of extra financial burden on patients, especially in low‐income countries. Moreover, the safety of antiviral agents still remains one of the major concerns.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, combined use of hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine (HBVac) was recommended by WHO to interrupt the vertical transmission of HBV. According to a deterministic mathematical transmission modelling study, approximately 210 million infants had been protected from HBV infection, owing to the application of the HBVac, by the year 2015 . However, the MTCT is more likely to occur in pregnant women with high viral load (HBV DNA > 10 6 IU/mL) and no antiviral treatment, even if both HBIG and HBVac immunizations have been applied, namely, interruption failure .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Song

Yang

Wang

et al. 2018

Journal of Viral Hepatitis

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Summary Nucleo(t)side analogues (NAs) have been administered as adjunctive therapy to interrupt the mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV). The efficacy and safety of this method remain controversial. A meta‐analysis was conducted to evaluate the efficacy and safety of NAs treatment during pregnancy. The differences among different agents and initiation trimesters were analysed. A total of 9228 mother‐infant pairs in 59 studies (32 RCTs and 27 non‐RCTs) were included in this meta‐analysis. NAs significantly reduced the risk of MTCT, as indicated by seropositivity of hepatitis B surface antigen (HBsAg) (risk ratio (RR) = 0.51, 95% confidence interval (CI) 0.45‐0.57) and HBV DNA in newborns (RR = 0.22, 95% CI 0.18‐0.26). No differences in the efficacy of interrupting HBV MTCT were evident among lamivudine, telbivudine and tenofovir disoproxil fumarate. NA was more effective when administered from the second than from the third trimester as indicated by HBV DNA (RR: the second vs the third 0.08 vs 0.22, P = 0.010), but this effect was not evident as indicated by HBsAg (RR: the second vs the third 0.46 vs 0.53, P = 0.596). Antiviral treatment initiated from the second trimester did not confer a higher risk of safety problems in the newborns compared with treatment from the third trimester, as indicated by weight (P = 0.064), length (P = 0.491) and malformation rate (P = 0.635) of newborns. Conclusions Lamivudine, telbivudine and tenofovir disoproxil fumarate are equally effective in blocking HBV MTCT. Antiviral treatment can be applied from the second trimester, without obvious safety concerns.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Song

Yang

Wang

et al. 2018

Journal of Viral Hepatitis

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“…Alternatively, population-wide screening and treatment of HBV may reduce these deaths, as suggested by a recent modelling study [24]. We assessed factors associated with HBsAg seropositivity to identify sub-groups of the population with an increased risk of chronic HBV infection.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of chronic hepatitis B virus infection and infrastructure for its diagnosis in Madagascar: implication for the WHO’s elimination strategy

et al. 2017

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BackgroundWHO developed a global strategy to eliminate hepatitis B by 2030 and set target to treat 80% of people with chronic hepatitis B virus (HBV) infection eligible for antiviral treatment. As a first step to achieve this goal, it is essential to conduct a situation analysis that is fundamental to designing national hepatitis plans. We therefore estimated the prevalence of chronic HBV infection, and described the existing infrastructure for HBV diagnosis in Madagascar.MethodsWe conducted a stratified multi-stage serosurvey of hepatitis B surface antigen (HBsAg) in adults aged ≥18 years using 28 sentinel surveillance sites located throughout the country. We obtained the list of facilities performing HBV testing from the Ministry of Health, and contacted the person responsible at each facility.ResultsA total of 1778 adults were recruited from the 28 study areas. The overall weighted seroprevalence of HBsAg was 6.9% (95% CI: 5.6–8.6). Populations with a low socio-economic status and those living in rural areas had a significantly higher seroprevalence of HBsAg. The ratio of facilities equipped to perform HBsAg tests per 100,000 inhabitants was 1.02 in the capital city of Antananarivo and 0.21 outside the capital. There were no facilities with the capacity to perform HBV DNA testing or transient elastography to measure liver fibrosis. There are only five hepatologists in Madagascar.ConclusionMadagascar has a high-intermediate level of endemicity for HBV infection with a severely limited capacity for its diagnosis and treatment. Higher HBsAg prevalence in rural or underprivileged populations underlines the importance of a public health approach to decentralize the management of chronic HBV carriers in Madagascar by using simple and low-cost diagnostic tools.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4630-z) contains supplementary material, which is available to authorized users.

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“…Unfortunately, 240 million people are influenced by HBV infection 2 with nearly 1 million deaths every year 3 . HBV infection can be transmitted through different routes such as mother to child, donation blood, sexual contact, intravenous drug use and medical exposure 4 .…”

Section: Introductionmentioning

confidence: 99%

Improved Analytical Sensitivity of Lateral Flow Assay using Sponge for HBV Nucleic Acid Detection

Tang

Yang

Gong

et al. 2017

Sci Rep

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Hepatitis B virus (HBV) infection is a serious public health problem, which can be transmitted through various routes (e.g., blood donation) and cause hepatitis, liver cirrhosis and liver cancer. Hence, it is necessary to do diagnostic screening for high-risk HBV patients in these transmission routes. Nowadays, protein-based technologies have been used for HBV testing, which however involve the issues of large sample volume, antibody instability and poor specificity. Nucleic acid hybridization-based lateral flow assay (LFA) holds great potential to address these limitations due to its low-cost, rapid, and simple features, but the poor analytical sensitivity of LFA restricts its application. In this study, we developed a low-cost, simple and easy-to-use method to improve analytical sensitivity by integrating sponge shunt into LFA to decrease the fluid flow rate. The thickness, length and hydrophobicity of the sponge shunt were sequentially optimized, and achieved 10-fold signal enhancement in nucleic acid testing of HBV as compared to the unmodified LFA. The enhancement was further confirmed by using HBV clinical samples, where we achieved the detection limit of 103 copies/ml as compared to 104 copies/ml in unmodified LFA. The improved LFA holds great potential for diseases diagnostics, food safety control and environment monitoring at point-of-care.

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Requirements for global elimination of hepatitis B: a modelling study

Abstract: Medical Research Council.

Cited by 319 publications

References 35 publications

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Prevalence of chronic hepatitis B virus infection and infrastructure for its diagnosis in Madagascar: implication for the WHO’s elimination strategy

Improved Analytical Sensitivity of Lateral Flow Assay using Sponge for HBV Nucleic Acid Detection

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