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Feasibility of hepatitis B elimination in high-income countries with ongoing immigration

  • Feng Tian
    Affiliations
    School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
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  • Jordan J. Feld
    Affiliations
    Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
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  • Zeny Feng
    Affiliations
    Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
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  • Beate Sander
    Affiliations
    Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada

    Public Health Ontario, Toronto, Ontario, Canada
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  • William W.L. Wong
    Correspondence
    Corresponding author. Address: School of Pharmacy, Faculty of Science, University of Waterloo, PHR4011, 10A Victoria Street S, Kitchener, Ontario, Canada, N2G1C5; Tel.: 519-888-4567, ext. 21323; fax: +1 519-883-7580.
    Affiliations
    School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada

    Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada
    Search for articles by this author
Published:April 25, 2022DOI:https://doi.org/10.1016/j.jhep.2022.04.014

      Highlights

      • We developed an agent-based model reflecting the dynamics of HBV transmission in a high-income country with ongoing immigration.
      • Current and scaled-up vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals.
      • Further medical research on curable treatments for CHB is urgently needed.
      • For an immigrant-receiving country, the WHO goals may not be realistic.
      • Formulation of immigration screening policies would allow for a reduction in HBV-related complications.

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Lay summary

      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.

      Graphical abstract

      Keywords

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