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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 25, 2022
Accepted:
April 13,
2022
Received in revised form:
April 11,
2022
Received:
February 4,
2022
Footnotes
Author names in bold designate shared co-first authorship.
Identification
Copyright
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
