School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.
Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.
J Hepatol. 2022 Oct;77(4):947-956. doi: 10.1016/j.jhep.2022.04.014. Epub 2022 Apr 26.
BACKGROUND & AIMS: Addressing HBV is vital to meeting the World Health Organization (WHO)'s viral hepatitis elimination goals, as 47% of viral hepatitis complications can be attributed to HBV. The objective of this study is to develop an agent-based model determining which integrated strategies involving vaccination, screening, and treatment would achieve the WHO's goals.
We developed an agent-based model to characterize the HBV epidemic in a high-income country with ongoing immigration. The spread of HBV was simulated through sexual networks and perinatal transmission. Model parameters were estimated from the literature and calibrated against historical HBV data. Sensitivity analyses were performed to assess the uncertainty.
We predict that under the current strategies, the incidence of acute hepatitis B, and HBV-attributable decompensated cirrhosis and hepatocellular carcinoma would decrease by 64.5%, 9.4%, and 10.5% between 2015-2030, respectively. However, the incidence of chronic hepatitis B and liver-related deaths would increase by 26.6% and 1.0% between 2015-2030, respectively. Results were sensitive to the number of immigrants and HBV prevalence in immigrants.
The results suggest that the current vaccination, screening, and treatment strategies will be inadequate to achieve WHO elimination goals. Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable, highlighting the need for a re-evaluation of the global strategy for HBV, the importance of developing curative therapy for HBV, and of establishing tailored strategies to prevent long-term sequelae and improve health in immigrants.
We have developed a model that reflects the dynamics of hepatitis B virus (HBV) transmission in a high-income country with ongoing immigration, which enabled us to forecast the epidemiology of HBV for policy-level decision making. Our analysis suggests that current vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals of eliminating chronic hepatitis B. Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable.
应对乙型肝炎病毒（HBV）对于实现世界卫生组织（WHO）的病毒性肝炎消除目标至关重要，因为 47%的病毒性肝炎并发症可归因于 HBV。本研究旨在开发一种基于代理的模型，以确定涉及疫苗接种、筛查和治疗的综合策略将如何实现世卫组织的目标。
我们开发了一种基于代理的模型，以描述一个高收入国家中不断有移民涌入的 HBV 流行情况。HBV 的传播通过性网络和围产期传播进行模拟。模型参数根据文献进行估计，并根据历史 HBV 数据进行校准。进行了敏感性分析以评估不确定性。
我们预测，在当前策略下，2015-2030 年期间，急性乙型肝炎、HBV 导致的失代偿性肝硬化和肝细胞癌的发病率将分别下降 64.5%、9.4%和 10.5%。然而，2015-2030 年期间，慢性乙型肝炎和与肝脏相关的死亡的发病率将分别增加 26.6%和 1.0%。结果对移民数量和移民中的 HBV 流行率敏感。
结果表明，当前的疫苗接种、筛查和治疗策略将不足以实现世卫组织的消除目标。即使在疫苗接种、筛查和治疗方面广泛进行综合扩大，发病率和死亡率目标也可能无法实现，这突出表明需要重新评估全球 HBV 战略，重视开发 HBV 治愈疗法，并制定针对移民的量身定制的策略以预防长期后遗症并改善其健康。
我们开发了一个模型，该模型反映了一个有持续移民的高收入国家中乙型肝炎病毒（HBV）传播的动态，使我们能够为政策制定者预测 HBV 的流行病学。我们的分析表明，当前的疫苗接种、筛查和治疗策略不足以实现世卫组织消除慢性乙型肝炎的目标。即使在疫苗接种、筛查和治疗方面进行广泛的综合扩大，发病率和死亡率目标也可能无法实现。
