Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK.
Lancet Infect Dis. 2016 Dec;16(12):1399-1408. doi: 10.1016/S1473-3099(16)30204-3. Epub 2016 Sep 13.
Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them.
We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic.
Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed.
Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis.
Medical Research Council.
尽管存在有效的预防和治疗干预措施，但乙型肝炎病毒（HBV）感染仍导致每年近 100 万人死亡。世卫组织渴望实现全球控制和消除 HBV 感染。我们旨在评估针对 HBV 的公共卫生干预措施的潜在影响，提出降低发病率和死亡率的目标，并确定实现这些目标所需的关键发展。
我们开发了一种全球 HBV 流行的模拟模型，其中包括 HBV 自然史、流行率、死亡率、疫苗接种覆盖率、治疗动态和人口统计学数据。我们估计了当前预防感染的干预措施的影响，以及扩大现有干预措施以进行广泛的人群筛查和治疗干预对全球流行的影响。
婴儿和新生儿的疫苗接种已经大大减少了新的感染；到 2015 年，疫苗接种已经预防了 2.1 亿例新的慢性感染，到 2030 年将避免 110 万人死亡。然而，如果不扩大现有干预措施的规模，我们的模型表明，由于一些地区的持续传播和已经感染的人获得治疗的机会有限，到 2015 年至 2030 年期间，将累计出现 6300 万例新的慢性感染病例和 1700 万例 HBV 相关死亡病例。通过扩大婴儿疫苗接种覆盖率（达到 90%的婴儿）、出生时疫苗接种覆盖率（达到 80%的新生儿）、使用围产期抗病毒药物（达到 80%的乙型肝炎 e 抗原阳性母亲）以及进行广泛的人群检测和治疗（达到 80%的合格人群），可以实现新的慢性感染减少 90%和死亡率降低 65%的目标。这些干预措施将在 2015 年至 2030 年期间避免 730 万人死亡，包括 150 万人死于癌症。到 2090 年，全球范围内将达到新的慢性感染发生率的消除阈值。全球每年的成本将达到 75 亿美元的峰值（低收入和中低收入国家为 34 亿美元），但随着时间的推移，这一成本将迅速下降，如果开发出一种治愈方法，这一成本将加速下降。
需要扩大疫苗接种覆盖率、创新可扩展的母婴传播预防选择以及雄心勃勃的广泛人群检测和治疗，以消除乙型肝炎作为一个主要的公共卫生威胁。实现这些目标将为实现可持续发展目标之一（抗击肝炎）做出重大贡献。
医学研究理事会。
