ABSTRACT
Sustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) as a public health concern by 2030. We evaluate the current and future role of HBV vaccination and prevention of mother to child transmission (PMTCT) as tools for elimination, through the combined scrutiny of a paediatric cohort in South Africa and a model to simulate transmission and prevention. Existing efforts have been successful in reducing prevalence of infection (HBsAg) in children to <1%. Our model anticipates that current combination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, but will reduce the prevalence of HBV e-antigen positive carriers more slowly, with potential implications for public health control. With strategies and resources already available, significant, positive public health impact is possible, although time to HBV elimination as a public health concern is likely to be longer than that proposed by current goals.
- ABBREVIATIONS
- 3TC
- Lamivudine
- Anti-HBc
- Antibody to hepatitis B core antigen (antibody mediated by exposure to infection)
- Anti-HBe
- Antibody to hepatitis B envelope antigen
- Anti-HBs
- Antibody to hepatitis B surface antigen (vaccine-mediated antibody)
- ART
- Anti-retroviral therapy
- COSAC
- Coinfection in South African children
- EPI
- Expanded Programme on Immunisation
- FTC
- Entecavir
- HBV
- Hepatitis B virus
- HBcAg
- Hepatitis B core antigen
- HBeAg
- Hepatitis B envelope antigen
- HBsAg
- Hepatitis B surface antigen
- HBIg
- Hepatitis B immunoglobulin
- HIV
- Human immunodeficiency virus (type 1)
- KReC
- Kimberley Respiratory Cohort
- PMTCT
- Prevention of mother to child transmission
- RTHB
- Road to Health Book
- TDF
- Tenofovir
- UN
- United Nations
- WHO
- World Health Organisation