Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa.
Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Lancet Gastroenterol Hepatol. 2017 Dec;2(12):900-909. doi: 10.1016/S2468-1253(17)30295-9.
The WHO global health sector strategy on viral hepatitis, created in May, 2016, aims to achieve a 90% reduction in new cases of chronic hepatitis B and C and a 65% reduction in mortality due to hepatitis B and C by 2030. Hepatitis B virus (HBV) is endemic in sub-Saharan Africa, and despite the introduction of universal hepatitis B vaccination and effective antiviral therapy, the estimated overall seroprevalence of hepatitis B surface antigen remains high at 6·1% (95% uncertainty interval 4·6-8·5). In this Series paper, we have reviewed the literature to examine the epidemiology, burden of liver disease, and elimination strategies of hepatitis B in sub-Saharan Africa. This paper reflects a supranational perspective of sub-Saharan Africa, and recommends several priority elimination strategies that address the need both to prevent new infections and to diagnose and treat chronic infections. The key to achieving these elimination goals in sub-Saharan Africa is the effective prevention of new infections via universal implementation of the HBV birth-dose vaccine, full vaccine coverage, access to affordable diagnostics to identify HBV-infected individuals, and to enable linkage to care and antiviral therapy.
世界卫生组织 2016 年 5 月制定的全球卫生部门病毒性肝炎战略旨在 2030 年实现以下目标：慢性乙型肝炎和丙型肝炎新发病例减少 90%，乙型肝炎和丙型肝炎导致的死亡率减少 65%。乙型肝炎病毒（HBV）在撒哈拉以南非洲流行，尽管已推行乙肝疫苗普遍接种和有效的抗病毒治疗，但乙型肝炎表面抗原总血清流行率估计仍居高不下，为 6.1%（95%置信区间 4.6-8.5）。本系列论文回顾了文献，以研究撒哈拉以南非洲乙型肝炎的流行病学、肝病负担和消除策略。本文反映了对撒哈拉以南非洲的跨国视角，并提出了若干消除乙型肝炎的优先战略，既需要预防新感染，也需要诊断和治疗慢性感染。在撒哈拉以南非洲实现这些消除目标的关键是通过普遍实施乙型肝炎婴儿首针疫苗、全面疫苗接种、获得负担得起的乙型肝炎感染诊断方法并将感染者纳入治疗，有效预防新感染。
