School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
Department of Infectious Disease Epidemiology, Imperial College London, London, England.
Bull World Health Organ. 2021 Jan 1;99(1):10-18. doi: 10.2471/BLT.19.248146. Epub 2020 Oct 28.
To determine the projected burden of hepatitis B virus (HBV) in China, the intervention strategies that can eliminate mother-to-child transmission (MTCT) by 2030 or earlier and the measurable parameters that can be used to monitor progress towards this target.
We developed a dynamic, sex- and age-stratified model of the HBV epidemic in China, calibrated using hepatitis B surface antigen (HBsAg) and e antigen (HBeAg) prevalence data from sequential national serosurveys (1979-2014) and the numbers of HBV-related cancer deaths (2012). We determined whether China can achieve elimination of MTCT of HBV by 2030 under current prevention interventions. We modelled various intervention scenarios to represent different coverage levels of birth-dose HBV vaccination, hepatitis B immunoglobulin to newborns of HBsAg-positive mothers and antiviral therapy (tenofovir) to HBeAg-positive pregnant women.
We project that, if current levels of prevention interventions are maintained, China will achieve the elimination target by 2029. By modelling various intervention scenarios, we found that this can be brought forward to 2025 by increasing coverage of birth-dose vaccination, or to 2024 by the administration of tenofovir to HBeAg-positive pregnant women. We found that achievement of the target by 2025 would be predicted by a measurement of less than 2% MTCT in 2020.
Our results highlight how high-quality national data can be combined with modelling in monitoring the elimination of MTCT of HBV. By demonstrating the impact of increased interventions on target achievement dates, we anticipate that other high-burden countries will be motivated to strengthen HBV prevention policies.
确定中国乙型肝炎病毒（HBV）的预计负担，到 2030 年或更早消除母婴传播（MTCT）的干预策略，以及可用于监测实现这一目标进展的可衡量参数。
我们开发了一个中国 HBV 流行的动态、性别和年龄分层模型，使用来自连续全国血清学调查（1979-2014 年）的乙型肝炎表面抗原（HBsAg）和 e 抗原（HBeAg）流行率数据以及乙型肝炎相关癌症死亡人数（2012 年）进行校准。我们确定中国是否可以在当前预防干预措施下实现到 2030 年消除 HBV 的 MTCT。我们建立了各种干预情景模型，以代表不同水平的新生儿乙型肝炎疫苗基础免疫接种、乙型肝炎免疫球蛋白（HBIG）用于 HBsAg 阳性母亲的新生儿和抗病毒治疗（替诺福韦）用于 HBeAg 阳性孕妇。
如果维持当前的预防干预水平，我们预计中国将在 2029 年实现消除目标。通过对各种干预情景进行建模，我们发现通过提高基础免疫接种覆盖率，可将这一时间提前到 2025 年，或通过对 HBeAg 阳性孕妇使用替诺福韦将时间提前到 2024 年。我们发现，如果 2020 年 MTCT 率低于 2%，则可以预测到 2025 年实现目标。
我们的结果强调了如何利用高质量的国家数据结合建模来监测消除 HBV 的 MTCT。通过证明增加干预措施对实现目标日期的影响，我们预计其他高负担国家将受到激励，加强乙型肝炎预防政策。
