Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi

Alexander J. Stockdale; James E. Meiring; Isaac T. Shawa; Deus Thindwa; Niza M. Silungwe; Maurice Mbewe; Rabson Kachala; Benno Kreuels; Pratiksha Patel; Priyanka Patel; Marc Henrion; Naor Bar-Zeev; Todd D. Swarthout; Robert S. Heyderman; Stephen Gordon; Anna Maria Geretti; Melita A. Gordon

doi:10.1093/infdis/jiab562

Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi

Alexander J. Stockdale, James E. Meiring, Isaac T. Shawa, Deus Thindwa, Niza M. Silungwe, Maurice Mbewe, Rabson Kachala, Benno Kreuels, Pratiksha Patel, Priyanka Patel, Marc Henrion, Naor Bar-Zeev, Todd D. Swarthout, Robert S. Heyderman, Stephen Gordon, Anna Maria Geretti, Melita A. Gordon

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

BACKGROUND

Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.

METHODS

We conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, 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.

RESULTS

Of 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (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.

CONCLUSIONS

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.

Original language	English
Pages (from-to)	871-880
Number of pages	10
Journal	Journal of Infectious Diseases
Volume	226
Issue number	5
Early online date	9 Nov 2021
DOIs	https://doi.org/10.1093/infdis/jiab562
Publication status	Published - 1 Sept 2022

Keywords

Africa
antiviral agents
epidemiology
hepatitis B
Malawi
public health
south of the Sahara
vaccination

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/infdis/jiab562Licence: CC BY

Stockdale etal2021 - MHenrionAccepted author manuscript, 588 KBLicence: CC BY

Cite this

Stockdale, A. J., Meiring, J. E., Shawa, I. T., Thindwa, D., Silungwe, N. M., Mbewe, M., Kachala, R., Kreuels, B., Patel, P., Patel, P., Henrion, M., Bar-Zeev, N., Swarthout, T. D., Heyderman, R. S., Gordon, S., Maria Geretti, A., & Gordon, M. A. (2022). Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi. Journal of Infectious Diseases, 226(5), 871-880. https://doi.org/10.1093/infdis/jiab562

@article{4daf8e9ce5bc42b19b8e0017ef0fc693,

title = "Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi",

abstract = "BACKGROUNDHepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.METHODSWe conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, 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.RESULTSOf 97,386 censused individuals, 6,073 (median age 18 years; 56.7\% female) were sampled. HBsAg seroprevalence was 5.1\% (95\% CI 4.3-6.1) among adults and 0.3\% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8\% (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.CONCLUSIONSInfant 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.",

keywords = "Africa, antiviral agents, epidemiology, hepatitis B, Malawi, public health, south of the Sahara, vaccination",

author = "Stockdale, \{Alexander J.\} and Meiring, \{James E.\} and Shawa, \{Isaac T.\} and Deus Thindwa and Silungwe, \{Niza M.\} and Maurice Mbewe and Rabson Kachala and Benno Kreuels and Pratiksha Patel and Priyanka Patel and Marc Henrion and Naor Bar-Zeev and Swarthout, \{Todd D.\} and Heyderman, \{Robert S.\} and Stephen Gordon and \{Maria Geretti\}, Anna and Gordon, \{Melita A.\}",

year = "2022",

month = sep,

day = "1",

doi = "10.1093/infdis/jiab562",

language = "English",

volume = "226",

pages = "871--880",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

publisher = "Oxford University Press",

number = "5",

}

Stockdale, AJ, Meiring, JE, Shawa, IT, Thindwa, D, Silungwe, NM, Mbewe, M, Kachala, R, Kreuels, B, Patel, P, Patel, P, Henrion, M, Bar-Zeev, N, Swarthout, TD, Heyderman, RS, Gordon, S, Maria Geretti, A & Gordon, MA 2022, 'Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi', Journal of Infectious Diseases, vol. 226, no. 5, pp. 871-880. https://doi.org/10.1093/infdis/jiab562

TY - JOUR

T1 - Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi

AU - Stockdale, Alexander J.

AU - Meiring, James E.

AU - Shawa, Isaac T.

AU - Thindwa, Deus

AU - Silungwe, Niza M.

AU - Mbewe, Maurice

AU - Kachala, Rabson

AU - Kreuels, Benno

AU - Patel, Pratiksha

AU - Patel, Priyanka

AU - Henrion, Marc

AU - Bar-Zeev, Naor

AU - Swarthout, Todd D.

AU - Heyderman, Robert S.

AU - Gordon, Stephen

AU - Maria Geretti, Anna

AU - Gordon, Melita A.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - BACKGROUNDHepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.METHODSWe conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, 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.RESULTSOf 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (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.CONCLUSIONSInfant 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.

AB - BACKGROUNDHepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.METHODSWe conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, 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.RESULTSOf 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (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.CONCLUSIONSInfant 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.

KW - Africa

KW - antiviral agents

KW - epidemiology

KW - hepatitis B

KW - Malawi

KW - public health

KW - south of the Sahara

KW - vaccination

U2 - 10.1093/infdis/jiab562

DO - 10.1093/infdis/jiab562

M3 - Article

SN - 0022-1899

VL - 226

SP - 871

EP - 880

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 5

ER -

Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi

Abstract

Keywords

UN SDGs

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