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- Title
Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi.
- Authors
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 Y R; Bar-Zeev, Naor; Swarthout, Todd D; Heyderman, Robert S; Gordon, Stephen B; Geretti, Anna Maria; Gordon, Melita A; Maria Geretti, Anna
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
MALAWI; HIV infection epidemiology; HEPATITIS B prevention; HEPATITIS B; HIV infections; VIRAL antigens; IMMUNIZATION; HEPATITIS viruses; ANTIVIRAL agents; RESEARCH funding; HEPATITIS B vaccines; EPIDEMIOLOGICAL research
- Publication
Journal of Infectious Diseases, 2022, Vol 226, Issue 5, p871
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiab562