Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi



Stockdale, Alexander J ORCID: 0000-0002-5828-3328, Meiring, James E, Shawa, Isaac T, Thindwa, Deus, Silungwe, Niza M, Mbewe, Maurice, Kachala, Rabson, Kreuels, Benno, Patel, Pratiksha, Patel, Priyanka
et al (show 7 more authors) (2022) Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi. JOURNAL OF INFECTIOUS DISEASES, 226 (5). pp. 871-880.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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
Uncontrolled Keywords: hepatitis B, vaccination, epidemiology, antiviral agents, Malawi, Africa, south of the Sahara, public health
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 10 Nov 2021 10:31
Last Modified: 18 Jan 2023 21:25
DOI: 10.1093/infdis/jiab562
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3143001