Application of sero- epidemiology data to inform interventions for HBV in Africa: should diagnosis and treatment replace catch-up vaccination?
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health
Abstract
International goals for hepatitis B virus (HBV) infection set ambitious
targets for elimination by 2030. In populations with a high prevalence of infection,
catch-up HBV vaccination of adults is sometimes deployed. An alternative approach
of ‘test and treat’ could be applied as a population intervention for HBV.
Methods: We used a systematic approach to determine the relationship between
prevalence of HBV infection (HBsAg) and exposure (anti-HBc) in Africa. We applied
a mathematical model to compare the impact of catch-up vaccination with a ‘test and
treat’ strategy in a high prevalence setting.
Findings: There is a strong relationship between the prevalence of HBsAg and anti-
HBc (p<0·0001) across Africa, but the pattern differs between regions. Our data can
be interactively visualised at https://hbv-geo.shinyapps.io/oxafricahbv/. In settings
with high prevalence of infection, catch-up vaccination may have a transient effect.
However, this intervention does not contribute to a sustained decline in prevalence,
because a high proportion of adults are either already infected or immune as a result
of prior exposure. In contrast, diagnosing and treating infection has a marked impact
on reducing prevalence, equivalent to that of neonatal vaccination.
Interpretation: We have developed a high-resolution picture of HBV epidemiology
across Africa. In combination with robust neonatal vaccination programmes, testing
and treating infection is likely to be of more benefit than catch-up vaccination. This
alternative not only benefits the infected individual, but also has impact on
transmission, thus contributing to sustained reductions in population prevalence.
Description
Keywords
HBV, Vaccination, Epidemiology, Prevalence, Catch-up, Booster, Elimination, Immunization, Sustainable development goals, Africa, Uganda
Citation
McNaughton, A., Lourenço, J., Bester, P. A., Mokaya, J., Lumley, S. F., Forde, D., ... & Matthews, P. C. (2018). Application of Sero-Epidemiology Data to Inform Interventions for HBV in Africa: Should Diagnosis and Treatment Replace Catch-Up Vaccination?.