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1. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020

Author

Blach, Sarah, Terrault, Norah A, Tacke, Frank, Gamkrelidze, Ivane, Craxi, Antonio, Tanaka, Junko, Waked, Imam, Dore, Gregory J, Abbas, Zaigham, Abdallah, Ayat R, Abdulla, Maheeba, Aghemo, Alessio, Aho, Inka, Akarca, Ulus S, Alalwan, Abduljaleel M, Alanko Blomé, Marianne, Al-Busafi, Said A, Aleman, Soo, Alghamdi, Abdullah S, Al-Hamoudi, Waleed K, Aljumah, Abdulrahman A, Al-Naamani, Khalid, Al Serkal, Yousif M, Altraif, Ibrahim H, Anand, Anil C, Anderson, Motswedi, Andersson, Monique I, Athanasakis, Kostas, Baatarkhuu, Oidov, Bakieva, Shokhista R, Ben-Ari, Ziv, Bessone, Fernando, Biondi, Mia J, Bizri, Abdul Rahman N, Brandão-Mello, Carlos E, Brigida, Krestina, Brown, Kimberly A, Brown Jr, Robert S, Bruggmann, Philip, Brunetto, Maurizia R, Busschots, Dana, Buti, Maria, Butsashvili, Maia, Cabezas, Joaquin, Chae, Chungman, Chaloska Ivanova, Viktorija, Chan, Henry Lik Yuen, Cheinquer, Hugo, Cheng, Kent Jason, Cheon, Myeong-Eun, Chien, Cheng-Hung, Chien, Rong-Nan, Choudhuri, Gourdas, Christensen, Peer Brehm, Chuang, Wan-Long, Chulanov, Vladimir, Cisneros, Laura E, Coco, Barbara, Contreras, Fernando A, Cornberg, Markus, Cramp, Matthew E, Crespo, Javier, Cui, Fuqiang, Cunningham, Chris W, Dagher Abou, Lucy, Dalgard, Olav, Dao, Doan Y, De Ledinghen, Victor, Derbala, Moutaz F, Deuba, Keshab, Dhindsa, Karan, Djauzi, Samsuridjal, Drazilova, Sylvia, Duberg, Ann-Sofi, Elbadri, Mohammed, El-Sayed, Manal H, Esmat, Gamal, Estes, Chris, Ezzat, Sameera, Färkkilä, Martti A, Ferradini, Laurent, Ferraz, Maria Lucia G, Ferreira, Paulo R A, Filipec Kanizaj, Tajana, Flisiak, Robert, Frankova, Sona, Fung, James, Gamkrelidze, Amiran, Gane, Edward, Garcia, Virginia, García-Samaniego, Javier, Gemilyan, Manik, Genov, Jordan, Gheorghe, Liliana S, Gholam, Pierre M, Goldis, Adrian, Gottfredsson, Magnus, Gray, Richard T, Grebely, Jason, Gschwantler, Michael, Hajarizadeh, Behzad, Hamid, Saeed S, Hamoudi, Waseem, Hatzakis, Angelos, Hellard, Margaret E, Himatt, Sayed, Hofer, Harald, Hrstic, Irena, Hunyady, Bela, Husa, Petr, Husic-Selimovic, Azra, Jafri, Wasim S M, Janicko, Martin, Janjua, Naveed, Jarcuska, Peter, Jaroszewicz, Jerzy, Jerkeman, Anna, Jeruma, Agita, Jia, Jidong, Jonasson, Jon G, Kåberg, Martin, Kaita, Kelly D E, Kaliaskarova, Kulpash S, Kao, Jia-Horng, Kasymov, Omor T, Kelly-Hanku, Angela, Khamis, Faryal, Khamis, Jawad, Khan, Aamir G, Khandu, Lekey, Khoudri, Ibtissam, Kielland, Knut B, Kim, Do Young, Kodjoh, Nicolas, Kondili, Loreta A, Krajden, Mel, Krarup, Henrik Bygum, Kristian, Pavol, Kwon, Jisoo A, Lagging, Martin, Laleman, Wim, Lao, Wai Cheung, Lavanchy, Daniel, Lázaro, Pablo, Lazarus, Jeffrey V, Lee, Alice U, Lee, Mei-Hsuan, Li, Michael K K, Liakina, Valentina, Lim, Young-Suk, Löve, Arthur, Lukšić, Boris, Machekera, Shepherd Mufudzi, Malu, Abraham O, Marinho, Rui T, Maticic, Mojca, Mekonnen, Hailemichael D, Mendes-Correa, Maria Cássia, Mendez-Sanchez, Nahum, Merat, Shahin, Meshesha, Berhane Redae, Midgard, Håvard, Mills, Mike, Mohamed, Rosmawati, Mooneyhan, Ellen, Moreno, Christophe, Muljono, David H, Müllhaupt, Beat, Musabaev, Erkin, Muyldermans, Gaëtan, Nartey, Yvonne Ayerki, Naveira, Marcelo C M, Negro, Francesco, Nersesov, Alexander V, Njouom, Richard, Ntagirabiri, Rénovat, Nurmatov, Zuridin S, Obekpa, Solomon A, Oguche, Stephen, Olafsson, Sigurdur, Ong, Janus P, Opare-Sem, Ohene K, Orrego, Mauricio, Øvrehus, Anne L, Pan, Calvin Q, Papatheodoridis, George V, Peck-Radosavljevic, Markus, Pessoa, Mário G, Phillips, Richard O, Pimenov, Nikolay, Plaseska-Karanfilska, Dijana, Prabdial-Sing, Nishi N, Puri, Pankaj, Qureshi, Huma, Rahman, Aninda, Ramji, Alnoor, Razavi-Shearer, Devin M, Razavi-Shearer, Kathryn, Ridruejo, Ezequiel, Ríos-Hincapié, Cielo Y, Rizvi, S M Shahriar, Robaeys, Geert K M M, Roberts, Lewis R, Roberts, Stuart K, Ryder, Stephen D, Sadirova, Shakhlo, Saeed, Umar, Safadi, Rifaat, Sagalova, Olga, Said, Sanaa S, Salupere, Riina, Sanai, Faisal M, Sanchez-Avila, Juan F, Saraswat, Vivek A, Sarrazin, Christoph, Sarybayeva, Gulya, Seguin-Devaux, Carole, Sharara, Ala I, Sheikh, Mahdi, Shewaye, Abate B, Sievert, William, Simojoki, Kaarlo, Simonova, Marieta Y, Sonderup, Mark W, Spearman, C Wendy, Sperl, Jan, Stauber, Rudolf E, Stedman, Catherine A M, Su, Tung-Hung, Suleiman, Anita, Sypsa, Vana, Tamayo Antabak, Natalia, Tan, Soek-Siam, Tergast, Tammo L, Thurairajah, Prem H, Tolmane, Ieva, Tomasiewicz, Krzysztof, Tsereteli, Maia, Uzochukwu, Benjamin S C, Van De Vijver, David A M C, Van Santen, Daniela K, Van Vlierberghe, Hans, Van Welzen, Berend, Vanwolleghem, Thomas, Vélez-Möller, Patricia, Villamil, Federico, Vince, Adriana, Waheed, Yasir, Weis, Nina, Wong, Vincent W-S, Yaghi, Cesar G, Yesmembetov, Kakharman, Yosry, Ayman, Yuen, Man-Fung, Yunihastuti, Evy, Zeuzem, Stefan, Zuckerman, Eli, Razavi, Homie A, Polaris Observatory HCV Collaborators, Virology, Blach, Sarah, Terrault, Norah A, Tacke, Frank, Gamkrelidze, Ivane, Craxi, Antonio, Tanaka, Junko, Waked, Imam, Dore, Gregory J, Abbas, Zaigham, Abdallah, Ayat R, Abdulla, Maheeba, Aghemo, Alessio, Aho, Inka, Akarca, Ulus S, Alalwan, Abduljaleel M, Alanko Blomé, Marianne, Al-Busafi, Said A, Aleman, Soo, Alghamdi, Abdullah S, Al-Hamoudi, Waleed K, Aljumah, Abdulrahman A, Al-Naamani, Khalid, Al Serkal, Yousif M, Altraif, Ibrahim H, Anand, Anil C, Anderson, Motswedi, Andersson, Monique I, Athanasakis, Kosta, Baatarkhuu, Oidov, Bakieva, Shokhista R, Ben-Ari, Ziv, Bessone, Fernando, Biondi, Mia J, Bizri, Abdul Rahman N, Brandão-Mello, Carlos E, Brigida, Krestina, Brown, Kimberly A, Brown, Jr, Robert S, Bruggmann, Philip, Brunetto, Maurizia R, Busschots, Dana, Buti, Maria, Butsashvili, Maia, Cabezas, Joaquin, Chae, Chungman, Chaloska Ivanova, Viktorija, Chan, Henry Lik Yuen, Cheinquer, Hugo, Cheng, Kent Jason, Cheon, Myeong-Eun, Chien, Cheng-Hung, Chien, Rong-Nan, Choudhuri, Gourda, Christensen, Peer Brehm, Chuang, Wan-Long, Chulanov, Vladimir, Cisneros, Laura E, Coco, Barbara, Contreras, Fernando A, Cornberg, Marku, Cramp, Matthew E, Crespo, Javier, Cui, Fuqiang, Cunningham, Chris W, Dagher Abou, Lucy, Dalgard, Olav, Dao, Doan Y, De Ledinghen, Victor, Derbala, Moutaz F, Deuba, Keshab, Dhindsa, Karan, Djauzi, Samsuridjal, Drazilova, Sylvia, Duberg, Ann-Sofi, Elbadri, Mohammed, El-Sayed, Manal H, Esmat, Gamal, Estes, Chri, Ezzat, Sameera, Färkkilä, Martti A, Ferradini, Laurent, Ferraz, Maria Lucia G, Ferreira, Paulo R A, Filipec Kanizaj, Tajana, Flisiak, Robert, Frankova, Sona, Fung, Jame, Gamkrelidze, Amiran, Gane, Edward, Garcia, Virginia, García-Samaniego, Javier, Gemilyan, Manik, Genov, Jordan, Gheorghe, Liliana S, Gholam, Pierre M, Goldis, Adrian, Gottfredsson, Magnu, Gray, Richard T, Grebely, Jason, Gschwantler, Michael, Hajarizadeh, Behzad, Hamid, Saeed S, Hamoudi, Waseem, Hatzakis, Angelo, Hellard, Margaret E, Himatt, Sayed, Hofer, Harald, Hrstic, Irena, Hunyady, Bela, Husa, Petr, Husic-Selimovic, Azra, Jafri, Wasim S M, Janicko, Martin, Janjua, Naveed, Jarcuska, Peter, Jaroszewicz, Jerzy, Jerkeman, Anna, Jeruma, Agita, Jia, Jidong, Jonasson, Jon G, Kåberg, Martin, Kaita, Kelly D E, Kaliaskarova, Kulpash S, Kao, Jia-Horng, Kasymov, Omor T, Kelly-Hanku, Angela, Khamis, Faryal, Khamis, Jawad, Khan, Aamir G, Khandu, Lekey, Khoudri, Ibtissam, Kielland, Knut B, Kim, Do Young, Kodjoh, Nicola, Kondili, Loreta A, Krajden, Mel, Krarup, Henrik Bygum, Kristian, Pavol, Kwon, Jisoo A, Lagging, Martin, Laleman, Wim, Lao, Wai Cheung, Lavanchy, Daniel, Lázaro, Pablo, Lazarus, Jeffrey V, Lee, Alice U, Lee, Mei-Hsuan, Li, Michael K K, Liakina, Valentina, Lim, Young-Suk, Löve, Arthur, Lukšić, Bori, Machekera, Shepherd Mufudzi, Malu, Abraham O, Marinho, Rui T, Maticic, Mojca, Mekonnen, Hailemichael D, Mendes-Correa, Maria Cássia, Mendez-Sanchez, Nahum, Merat, Shahin, Meshesha, Berhane Redae, Midgard, Håvard, Mills, Mike, Mohamed, Rosmawati, Mooneyhan, Ellen, Moreno, Christophe, Muljono, David H, Müllhaupt, Beat, Musabaev, Erkin, Muyldermans, Gaëtan, Nartey, Yvonne Ayerki, Naveira, Marcelo C M, Negro, Francesco, Nersesov, Alexander V, Njouom, Richard, Ntagirabiri, Rénovat, Nurmatov, Zuridin S, Obekpa, Solomon A, Oguche, Stephen, Olafsson, Sigurdur, Ong, Janus P, Opare-Sem, Ohene K, Orrego, Mauricio, Øvrehus, Anne L, Pan, Calvin Q, Papatheodoridis, George V, Peck-Radosavljevic, Marku, Pessoa, Mário G, Phillips, Richard O, Pimenov, Nikolay, Plaseska-Karanfilska, Dijana, Prabdial-Sing, Nishi N, Puri, Pankaj, Qureshi, Huma, Rahman, Aninda, Ramji, Alnoor, Razavi-Shearer, Devin M, Razavi-Shearer, Kathryn, Ridruejo, Ezequiel, Ríos-Hincapié, Cielo Y, Rizvi, S M Shahriar, Robaeys, Geert K M M, Roberts, Lewis R, Roberts, Stuart K, Ryder, Stephen D, Sadirova, Shakhlo, Saeed, Umar, Safadi, Rifaat, Sagalova, Olga, Said, Sanaa S, Salupere, Riina, Sanai, Faisal M, Sanchez-Avila, Juan F, Saraswat, Vivek A, Sarrazin, Christoph, Sarybayeva, Gulya, Seguin-Devaux, Carole, Sharara, Ala I, Sheikh, Mahdi, Shewaye, Abate B, Sievert, William, Simojoki, Kaarlo, Simonova, Marieta Y, Sonderup, Mark W, Spearman, C Wendy, Sperl, Jan, Stauber, Rudolf E, Stedman, Catherine A M, Su, Tung-Hung, Suleiman, Anita, Sypsa, Vana, Tamayo Antabak, Natalia, Tan, Soek-Siam, Tergast, Tammo L, Thurairajah, Prem H, Tolmane, Ieva, Tomasiewicz, Krzysztof, Tsereteli, Maia, Uzochukwu, Benjamin S C, Van De Vijver, David A M C, Van Santen, Daniela K, Van Vlierberghe, Han, Van Welzen, Berend, Vanwolleghem, Thoma, Vélez-Möller, Patricia, Villamil, Federico, Vince, Adriana, Waheed, Yasir, Weis, Nina, Wong, Vincent W-S, Yaghi, Cesar G, Yesmembetov, Kakharman, Yosry, Ayman, Yuen, Man-Fung, Yunihastuti, Evy, Zeuzem, Stefan, Zuckerman, Eli, and Razavi, Homie A

Subjects
Viremia/epidemiology, Genotype Distribution, Hepatitis C/epidemiology, Hepatology, Epidemiology, Gastroenterology, Infant, Newborn, COVID-19, Hepacivirus, Hepatitis A, Todays Treatment Paradigm, Infections, Hepatitis C, Future Disease Burden, SDG 3 - Good Health and Well-being, HCV, future disease burden, todays treatment paradigm, genotype distribution, epidemiology, infections, Prevalence, Humans, Human medicine, Viremia, Pandemics, COVID-19/epidemiology
Abstract

Background Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. Methods This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age =0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. Findings Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0.7% (95% UI 0.7-0.9), corresponding to 56.8 million (95% UI 55.2-67.8) infections, on Jan 1, 2020. This number represents a decrease of 6.8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63.6 million (61.8-75.8) infections (0.9% [0.8-1.0] prevalence). By the end of 2020, an estimated 12.9 million (12.5-15.4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000-765 000) patients initiated treatment. Interpretation At the beginning of 2020, there were an estimated 56.8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination. Copyright (C) 2022 Elsevier Ltd. All rights reserved., John C Martin Foundation [2019-G024]; Gilead Sciences [IN-US-987-5808]; AbbVie [4200907861]; ZeShan Foundation [2021-0101-1-CDA-HEP-10]; The Hepatitis Fund; Ministry of Health, Labour and Welfare of Japan [19HC1001], This analysis was funded by a grant from the John C Martin Foundation (2019-G024) through the Polaris Observatory for low-income and middleincome countries. Grants for analyses in high-income countries and territories were provided by Gilead Sciences (IN-US-987-5808) and AbbVie (4200907861). ZeShan Foundation (2021-0101-1-CDA-HEP-10) supported country and regional analyses in Asia and The Hepatitis Fund supported country and regional analyses in Africa. We thank the Epidemiological Research Group on the Burden of Viral Hepatitis and Measures for its Elimination (grant number 19HC1001; led by JT) funded by the Ministry of Health, Labour and Welfare of Japan. We thank the contributors included in the appendix (pp 2-3), who contributed to the country or territory analyses but did not meet authorship requirements.

Published
2022

2. Epidemiology and natural history of hepatitis C virus infection

Author

Lee, Mei-Hsuan, Yang, Hwai-I, Yuan, Yong, L’Italien, Gilbert, and Chen, Chien-Jen

Subjects
Adult, Aged, 80 and over, Liver Cirrhosis, Male, Carcinoma, Hepatocellular, Time Factors, Incidence, Liver Neoplasms, Age Factors, Taiwan, virus diseases, Hepacivirus, Middle Aged, Viral Load, Prognosis, Hepatitis C, digestive system diseases, Sex Factors, Risk Factors, Disease Progression, Prevalence, Humans, Female, Topic Highlight, Aged
Abstract

Hepatitis C virus (HCV) affects 130-210 million people worldwide and is one of the major risk factors for hepatocellular carcinoma. Globally, at least one third of hepatocellular carcinoma cases are attributed to HCV infection, and 350000 people died from HCV related diseases per year. There is a great geographical variation of HCV infection globally, with risk factors for the HCV infection differing in various countries. The progression of chronic hepatitis C to end-stage liver disease also varies in different study populations. A long-term follow-up cohort enrolling participants with asymptomatic HCV infection is essential for elucidating the natural history of HCV-caused hepatocellular carcinoma, and for exploring potential seromarkers that have high predictability for risk of hepatocellular carcinoma. However, prospective cohorts comprising individuals with HCV infection are still uncommon. The risk evaluation of viral load elevation and associated liver disease/cancer in HCV (REVEAL-HCV) study has followed a cohort of 1095 residents seropositive for antibodies against hepatitis C virus living in seven townships in Taiwan for more than fifteen years. Most of them have acquired HCV infection through iatrogenic transmission routes. As the participants in the REVEAL-HCV study rarely receive antiviral therapies, it provides a unique opportunity to study the natural history of chronic HCV infection. In this review, the prevalence, risk factors and natural history of HCV infection are comprehensively reviewed. The study cohort, data collection, and findings on liver disease progression of the REVEAL-HCV study are described.

Published
2014

5. IMPACT OF SVR ON LONG-TERM LIVER-RELATED OUTCOMES: RESULTS OF THE REAL-C REGISTRY AT 23 CENTERS FROM HONG KONG, KOREA, JAPAN AND TAIWAN

Author

Tanaka, Yasuhito, Toyoda, Hidenori, Jun, Dae Won, Enomoto, Masaru, Huang, Chung-Feng, Ogawa, Eiichi, Yasuda, Satoshi, Iio, Etsuko, Iwane, Shinji, Haga, Hiroaki, Dai, Chia-Yen, Jeong, Jae Yoon, Park, Seung Ha, Wong, Grace L., Lee, Dong Hyun, Takahashi, Hirokazu, Huang, Jee-Fu, Tran, Sally, Maeda, Mayumi, Cheung, Ramsey, Ueno, Yoshiyuki, Eguchi, Yuichiro, Hayashi, Jun, Furusyo, Norihiro, Tamori, Akihiro, Kumada, Takashi, Yu, Ming-Lung, Nguyen, Mindie H., Ahn, Sang Bong, Henry, Linda, Hsu, Yao-Chun, Huang, Ching-I, Jun, Mi Jung, Jung, Jang Han, Kam, Leslie, Lee, Mei-Hsuan, Liang, Po-Cheng, Mizuta, Akiko, Song, Do Seon, Tsai, Pei-Chien, Tseng, Cheng-Hao, Hwai-I Yang, Yeh, Ming-Lun, and Yoon, Eileen

6. Real-World Experience of All-Oral Directly Acting Antivirals in Asian Chronic Hepatitis C Patients-Real-World Evidence from the Asia Liver Consortium for HCV (REAL-C)

Author

Huang, Chung-Feng, Iio, Etsuko, Jun, Dae Won, Ogawa, Eiichi, Haga, Hiroaki, Enomoto, Masaru, Iwane, Shinji, Liu, Chen-Hua, Lee, Dong Hyun, Takahashi, Hirokazu, Wong, Grace L. H., Hwai-I Yang, Hayashi, Jun, Nomura, Hideyuki, Nakamuta, Makoto, Dai, Chia-Yen, Huang, Jee-Fu, Jun, Mi Jung, Lee, Mei-Hsuan, Tran, Sally, Henry, Linda, Kao, Jia-Horng, Eguchi, Yuichiro, Tamori, Akihiro, Ueno, Yoshiyuki, Tanaka, Yasuhito, Furusyo, Norihiro, Yu, Ming-Lung, Nguyen, Mindie H., Ahn, Sang Bong, Azuma, Koichi, Chuang, Wan-Long, Dohmen, Kazufumi, Jeong, Jae Yoon, Jung, Jang Han, Kajiwara, Eiji, Kato, Masaki, Kawano, Akira, Koyanagi, Toshimasa, Ooho, Aritsune, Park, Seung Ha, Satoh, Takeaki, Shimoda, Shinji, Song, Do Seon, Takahashi, Kazuhiro, Yeh, Ming-Lun, and Yoon, Eileen

7. Effectiveness and Safety of DAA Treatment for Chronic Hepatitis C Patients with Previous Hepatocellular Carcinoma: Results from a Real-World, Multicenter Study of Asian Countries

Author

Ogawa, Eiichi, Iio, Etsuko, Jun, Dae Won, Huang, Chung-Feng, Haga, Hiroaki, Enomoto, Masaru, Iwane, Shinji, Lee, Dong Hyun, Takahashi, Hirokazu, Wong, Grace L. H., Hwai-I Yang, Hayashi, Jun, Nomura, Hideyuki, Nakamuta, Makoto, Dai, Chia-Yen, Huang, Jee-Fu, Jun, Mi Jung, Lee, Mei-Hsuan, Tran, Sally, Henry, Linda, Eguchi, Yuichiro, Tamori, Akihiro, Ueno, Yoshiyuki, Yu, Ming-Lung, Tanaka, Yasuhito, Furusyo, Norihiro, Nguyen, Mindie H., Ahn, Sang Bong, Azuma, Koichi, Chuang, Wan-Long, Dohmen, Kazufumi, Jeong, Jae Yoon, Jung, Jang Han, Kajiwara, Eiji, Kato, Masaki, Kawano, Akira, Koyanagi, Toshimasa, Ooho, Aritsune, Park, Seung Ha, Satoh, Takeaki, Shimoda, Shinji, Song, Do Seon, Takahashi, Kazuhiro, Yeh, Ming-Lun, and Yoon, Eileen

8. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study

Author

Mei Hsuan Lee, Maurizia Rossana Brunetto, Stefan Mauss, Sabahattin Kaymakoglu, CE Omuemu, Danjuma Adda, Philip Bruggmann, Beat Müllhaupt, Trân D Quang, Peter Jarcuska, Man-Fung Yuen, George V. Papatheodoridis, Rohani Jahis, Ding-Shinn Chen, Necati Örmeci, Christophe Moreno, Angelos Hatzakis, Antoine Abou Rached, Boris Lukšić, Thomas Berg, Renovat Ntagirabiri, Kathryn Razavi-Shearer, Sarah Blach, Gabriela Rjaskova, Samantha M Brandon, Jen Layden, Ohene Opare-Sem, Maria C Mendes Correa, Stefano Vella, Jan Sperl, Vincent Wai-Sun Wong, Hwai I. Yang, Stephen Oguche, Richard Njouom, Cielo Yaneth Rios, Yee Tak Hui, Behzad Hajarizadeh, Andy I. M. Hoepelman, Javier García-Samaniego, Ammal M. Metwally, Ivane Gamkrelidze, Julia A. Scott, Said A. Al-Busafi, Valentina Liakina, Zaigham Abbas, Olga Sagalova, Rifaat Safadi, Michael Manns, William Sievert, Seyed M Alavian, Kakharman Yesmembetov, Manal H El-Sayed, Juan Francisco Sánchez-Ávila, Wan-Long Chuang, Peter Stärkel, Ziv Ben-Ari, Chris Cunningham, Homie Razavi, Erkin Musabaev, Ulus Salih Akarca, Petr Urbánek, Gamal Shiha, Muhammed Aasim M Yusuf, Nina Weis, Hossein Poustchi, Ilias Gountas, E. A. Croes, Ayman Yosry, Reza Malekzadeh, Kostas Athanasakis, Agustín Albillos, Faleh Z. Al-Faleh, Christoph Sarrazin, Maria Buti, Arif Nawaz, Chung-Lin Yang, Kimberly Murphy, Adriana Vince, Aliya Konysbekova, Soek Siam Tan, Loreta A. Kondili, Mojca Matičič, Karolin Falconer, Hailemichael Desalegn, Alexander Nersesov, Ogu Omede, N. N. Pimenov, Nahum Méndez-Sánchez, Benjamin C Cowie, Helen Nde, Wai-cheung C Lao, Jordan Genov, Imam Waked, Joël Mossong, Ala I. Sharara, Henry Lik-Yuen Chan, Vivek A. Saraswat, Diego Alberto Cuellar, Devin Razavi-Shearer, Abraham O. Malu, Rui Tato Marinho, Huma Qureshi, Markus Cornberg, Faisal M. Sanai, Ching-kong K Loo, David Kershenobich, Pavol Kristian, Paulo R. Ferreira, Mel Krajden, Moon Seok Choi, Junko Tanaka, Faryal Al Lawati, Jonathan Schmelzer, Ann-Sofi Duberg, Jan Gerstoft, Lewis R. Roberts, Francesco Negro, Khalid Al Naamani, Wim Laleman, Solomon Obekpa, Henk W. Reesink, Tesia Shin, Richard Gray, Alnoor Ramji, Fadi H. Mourad, Abdul Rahman Bizri, Joop E. Arends, Shahin Merat, Krzysztof Tomasiewicz, Adkhamjon Mamatkulov, Jerzy Jaroszewicz, Peer Brehm Christensen, Adriaan J. van der Meer, Maheeba Abdulla, Frank Tacke, Cesar Yaghi, Pierre Van Damme, Christopher K Opio, Yasir Waheed, Joseph Woodring, Ponsiano Ocama, Zuridin Nurmatov, Bisi Bright, Van Thi Thuy Nguyen, Perttu Arkkila, Nick Walsh, Catherine A.M. Stedman, Mette Rye Clausen, Vladimir Chulanov, Antonio Craxì, Christophe Hézode, Abdulrahman Aljumah, Jeffrey V. Lazarus, Fuad Hasan, Sarah Robbins, Sona Frankova, Adrian Goldis, Rong-Nan Chien, Chris Estes, Stephen D. Ryder, Nguyen Thu Anh, Abate Bane, Muhammad S. Memon, Ken Pasini, Ivan Schréter, Sameer Alawadhi, Stuart K. Roberts, Steve S Egeonu, Anil C. Anand, Riina Salupere, Massimo Colombo, Giovanni Battista Gaeta, Maria Lucia Gomes Ferraz, Rosmawati Mohamed, Sylvia Drazilova, Hans Van Vlierberghe, Soo Aleman, Naveed Z. Janjua, Irena Hrstić, Manik Sharma, Carlos E Brandão Mello, Mario G. Pessoa, Berhane Redae, Mindie H. Nguyen, Petr Husa, Vana Sypsa, Samir Shah, Jacques E Mokhbat, Robert Flisiak, Carole Seguin-Devaux, Asad Chaudhry, Inka Aho, Sayed Himatt, Hamad I. Al-Ashgar, Young-Suk Lim, Stefan Zeuzem, University of Zurich, Polaris Observatory Collaborators, Polaris Observ Collaborators, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Experimental Immunology, Gastroenterology & Hepatology, Razavi-Shearer D, Gamkrelidze I, Nguyen MH, Chen DS, Van Damme P, Abbas Z, Abdulla M, Abou Rached A, Adda D, Aho I, Akarca U, Hasan F, Al Lawati F, Al Naamani K, Al-Ashgar HI, Alavian SM, Alawadhi S, Albillos A, Al-Busafi SA, Aleman S, Alfaleh FZ, Aljumah AA, Anand AC, Anh NT, Arends JE, Arkkila P, Athanasakis K, Bane A, Ben-Ari Z, Berg T, Bizri AR, Blach S, Brandão Mello CE, Brandon SM, Bright B, Bruggmann P, Brunetto M, Buti M, Chan HLY, Chaudhry A, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Clausen MR, Colombo M, Cornberg M, Cowie B, Craxi A, Croes EA, Cuellar DA, Cunningham C, Desalegn H, Drazilova S, Duberg AS, Egeonu SS, El-Sayed MH, Estes C, Falconer K, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gaeta GB, García-Samaniego J, Genov J, Gerstoft J, Goldis A, Gountas I, Gray R, Guimarães Pessôa M, Hajarizadeh B, Hatzakis A, Hézode C, Himatt SM, Hoepelman A, Hrstic I, Hui YT, Husa P, Jahis R, Janjua NZ, Jarčuška P, Jaroszewicz J, Kaymakoglu S, Kershenobich D, Kondili LA, Konysbekova A, Krajden M, Kristian P, Laleman W, Lao WC, Layden J, Lazarus JV, Lee MH, Liakina V, Lim YS, Loo CK, Lukšić B, Malekzadeh R, Malu AO, Mamatkulov A, Manns M, Marinho RT, Maticic M, Mauss S, Memon MS, Mendes Correa MC, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Mokhbat JE, Moreno C, Mossong J, Mourad FH, Müllhaupt B, Murphy K, Musabaev E, Nawaz A, Nde HM, Negro F, Nersesov A, Nguyen VTT, Njouom R, Ntagirabiri R, Nurmatov Z, Obekpa S, Ocama P, Oguche S, Omede O, Omuemu C, Opare-Sem O, Opio CK, Örmeci N, Papatheodoridis G, Pasini K, Pimenov N, Poustchi H, Quang TD, Qureshi H, Ramji A, Razavi-Shearer K, Redae B, Reesink HW, Rios CY, Rjaskova G, Robbins S, Roberts LR, Roberts SK, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Sanchez-Avila JF, Saraswat V, Sarrazin C, Schmelzer JD, Schréter I, Scott J, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shiha GE, Shin T, Sievert W, Sperl J, Stärkel P, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tomasiewicz K, Urbanek P, van der Meer AJ, Van Vlierberghe H, Vella S, Vince A, Waheed Y, Waked I, Walsh N, Weis N, Wong VW, Woodring J, Yaghi C, Yang HI, Yang CL, Yesmembetov K, Yosry A, Yuen MF, Yusuf MAM, Zeuzem S, Razavi H., Negro, Francesco, Razavi-Shearer, Devin, Gamkrelidze, Ivane, Nguyen, Mindie H, Chen, Ding-Shinn, Van Damme, Pierre, Abbas, Zaigham, Abdulla, Maheeba, Abou Rached, Antoine, Adda, Danjuma, Aho, Inka, Akarca, Ulu, Hasan, Fuad, Al Lawati, Faryal, Al Naamani, Khalid, Al-Ashgar, Hamad Ibrahim, Alavian, Seyed M, Alawadhi, Sameer, Albillos, Agustin, Al-Busafi, Said A, Aleman, Soo, Alfaleh, Faleh Z, Aljumah, Abdulrahman A, Anand, Anil C, Anh, Nguyen Thu, Arends, Joop E, Arkkila, Perttu, Athanasakis, Kosta, Bane, Abate, Ben-Ari, Ziv, Berg, Thoma, Bizri, Abdul R, Blach, Sarah, Brandão Mello, Carlos E, Brandon, Samantha M, Bright, Bisi, Bruggmann, Philip, Brunetto, Maurizia, Buti, Maria, Chan, Henry L Y, Chaudhry, Asad, Chien, Rong-Nan, Choi, Moon S, Christensen, Peer B, Chuang, Wan-Long, Chulanov, Vladimir, Clausen, Mette R, Colombo, Massimo, Cornberg, Marku, Cowie, Benjamin, Craxi, Antonio, Croes, Esther A, Cuellar, Diego Alberto, Cunningham, Chri, Desalegn, Hailemichael, Drazilova, Sylvia, Duberg, Ann-Sofi, Egeonu, Steve S, El-Sayed, Manal H, Estes, Chri, Falconer, Karolin, Ferraz, Maria L G, Ferreira, Paulo R, Flisiak, Robert, Frankova, Sona, Gaeta, Giovanni B, García-Samaniego, Javier, Genov, Jordan, Gerstoft, Jan, Goldis, Adrian, Gountas, Ilia, Gray, Richard, Guimarães Pessôa, Mário, Hajarizadeh, Behzad, Hatzakis, Angelo, Hézode, Christophe, Himatt, Sayed M, Hoepelman, Andy, Hrstic, Irena, Hui, Yee-Tak T, Husa, Petr, Jahis, Rohani, Janjua, Naveed Z, Jarčuška, Peter, Jaroszewicz, Jerzy, Kaymakoglu, Sabahattin, Kershenobich, David, Kondili, Loreta A, Konysbekova, Aliya, Krajden, Mel, Kristian, Pavol, Laleman, Wim, Lao, Wai-cheung C, Layden, Jen, Lazarus, Jeffrey V, Lee, Mei-Hsuan, Liakina, Valentina, Lim, Young-Suk S, Loo, Ching-kong K, Lukšić, Bori, Malekzadeh, Reza, Malu, Abraham O, Mamatkulov, Adkhamjon, Manns, Michael, Marinho, Rui T, Maticic, Mojca, Mauss, Stefan, Memon, Muhammad S, Mendes Correa, Maria C, Mendez-Sanchez, Nahum, Merat, Shahin, Metwally, Ammal M, Mohamed, Rosmawati, Mokhbat, Jacques E, Moreno, Christophe, Mossong, Joel, Mourad, Fadi H, Müllhaupt, Beat, Murphy, Kimberly, Musabaev, Erkin, Nawaz, Arif, Nde, Helen M, Nersesov, Alexander, Nguyen, Van Thi Thuy, Njouom, Richard, Ntagirabiri, Renovat, Nurmatov, Zuridin, Obekpa, Solomon, Ocama, Ponsiano, Oguche, Stephen, Omede, Ogu, Omuemu, Casimir, Opare-Sem, Ohene, Opio, Christopher K, Örmeci, Necati, Papatheodoridis, George, Pasini, Ken, Pimenov, Nikolay, Poustchi, Hossein, Quang, Trân D, Qureshi, Huma, Ramji, Alnoor, Razavi-Shearer, Kathryn, Redae, Berhane, Reesink, Henk W, Rios, Cielo Yaneth, Rjaskova, Gabriela, Robbins, Sarah, Roberts, Lewis R, Roberts, Stuart K, Ryder, Stephen D, Safadi, Rifaat, Sagalova, Olga, Salupere, Riina, Sanai, Faisal M, Sanchez-Avila, Juan F, Saraswat, Vivek, Sarrazin, Christoph, Schmelzer, Jonathan D, Schréter, Ivan, Scott, Julia, Seguin-Devaux, Carole, Shah, Samir R, Sharara, Ala I, Sharma, Manik, Shiha, Gamal E, Shin, Tesia, Sievert, William, Sperl, Jan, Stärkel, Peter, Stedman, Catherine, Sypsa, Vana, Tacke, Frank, Tan, Soek S, Tanaka, Junko, Tomasiewicz, Krzysztof, Urbanek, Petr, van der Meer, Adriaan J, Van Vlierberghe, Han, Vella, Stefano, Vince, Adriana, Waheed, Yasir, Waked, Imam, Walsh, Nichola, Weis, Nina, Wong, Vincent W, Woodring, Joseph, Yaghi, Cesar, Yang, Hwai-I, Yang, Chung-Lin, Yesmembetov, Kakharman, Yosry, Ayman, Yuen, Man-Fung, Yusuf, Muhammed Aasim M, Zeuzem, Stefan, and Razavi, Homie

Subjects
0301 basic medicine, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences, HBsAg, Pediatrics, Delphi Technique, Infectious Disease Transmission, CHRONIC HBV INFECTION, NATURAL-HISTORY, FOLLOW-UP, HBSAG, CARRIERS, AGE, COUNTRIES, DISEASE, ANTIGEN, COHORT, ddc:616.07, Global Health, medicine.disease_cause, 0302 clinical medicine, Prevalence, HBV, Child, ddc:616, Antiviral Agents/therapeutic use, education.field_of_study, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti, Chronic/drug therapy/epidemiology/prevention & control/transmission, Gastroenterology, Hepatitis B Surface Antigens/blood, Hepatitis B, 10219 Clinic for Gastroenterology and Hepatology, Child, Preschool, 030211 gastroenterology & hepatology, Viral hepatitis, Viral load, Adult, medicine.medical_specialty, Hepatitis B vaccine, Population, 610 Medicine & health, Antiviral Agents, Mass Vaccination, Hepatology, 03 medical and health sciences, Hepatitis B, Chronic, SDG 3 - Good Health and Well-being, medicine, Humans, 2715 Gastroenterology, Preschool, education, Disease burden, Hepatitis B virus, Hepatitis B Surface Antigens, business.industry, Viral Vaccines, medicine.disease, Infectious Disease Transmission, Vertical, Vertical/prevention & control, 030104 developmental biology, 2721 Hepatology, Human medicine, business
Abstract

PubMed: 29599078, 2-s2.0-85044540918, Background: The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment. Methods: In this modelling study, we used a Delphi process that included a literature review in PubMed and Embase, followed by interviews with experts, to quantify the historical epidemiology of HBV infection. We then used a dynamic HBV transmission and progression model to estimate the country-level and regional-level prevalence of HBsAg in 2016 and the effect of prophylaxis and treatment on disease burden. Findings: We developed models for 120 countries, 78 of which were populated with data approved by experts. Using these models, we estimated that the global prevalence of HBsAg in 2016 was 3·9% (95% uncertainty interval [UI] 3·4–4·6), corresponding to 291 992 000 (251 513 000–341 114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4·8 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1·8 (1·6–2·2) million infections were in children aged 5 years, with a prevalence of 1·4% (1·2–1·6). We estimated that 87% of infants had received the three-dose HBV vaccination in the first year of life, 46% had received timely birth-dose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load had received antiviral therapy to reduce mother-to-child transmission. Interpretation: Our estimate of HBV prevalence in 2016 differs from previous studies, potentially because we took into account the effect of infant prophylaxis and early childhood vaccination, as well as changing prevalence over time. Although some regions are well on their way to meeting prophylaxis and prevalence targets, all regions must substantially scale-up access to diagnosis and treatment to meet the global targets. Funding: John C Martin Foundation. © 2018 Elsevier Ltd, H28-kansei-ippan-001 National Academy of Sciences, NAS Novartis Roche World Health Organization, WHO Gilead Sciences Alnylam Pharmaceuticals AbbVie Meso Scale Diagnostics, MSD British Microcirculation Society, BMS Japan Society for the Promotion of Science, JSPS: 17H03589 Ministry of Health, Labour and Welfare, MHLW Vetenskapsrådet, VR Siemens Universiteit Antwerpen OLL-683801, DR-S, IGa, SB, SMB, CE, KM, HMN, KP, KR-S, SR, JDS, and HR report grants from John C Martin Foundation, during the conduct of the study, and grants from Gilead Sciences, AbbVie, WHO, National Academy of Sciences, Intercept Pharmaceuticals, and Boehringer Ingelheim, outside the submitted work. MHN reports grants and personal fees from Bristol-Myers Squibb (BMS), Gilead Sciences, and Janssen, and personal fees from Novartis, Anylam, and Dynavax, outside the submitted work. PVD acts as chief and principal investigator for vaccine trials done on behalf of the University of Antwerp, Belgium, for which the University obtains research grants from vaccine manufacturers; speaker's fees for presentations on vaccines are paid directly to an educational fund held by the University of Antwerp, and PVD receives no personal remuneration for this work. ACA reports personal fees from Mylan Pharmaceuticals, outside the submitted work. JEA reports fees paid to his hospital for participation on the advisory boards of Gilead Sciences, ViiV Healthcare, BMS, Janssen, and AbbVie, and grants from BMS, Merck Sharp & Dohme (MSD), AbbVie, and ViiV Healthcare, outside the submitted work. TB reports grants, personal fees, and non-financial support from AbbVie and Gilead Sciences; grants and personal fees from BMS, Janssen, Roche, MSD, and Sequana Medical; and personal fees from Bayer, Vertex, Tibotec, Intercept, Sirtex, and Alexion, outside the submitted work. PB reports grants and personal fees from AbbVie, Gilead Sciences, and MSD, outside the submitted work. MBr reports personal fees from BMS, Gilead Sciences, and Janssen, and grants from BMS, outside the submitted work. HLYC reports personal fees from Gilead Sciences, BMS, AbbVie, Roche, MedImmune, and Intellia, outside the submitted work. PBC reports grants from AbbVie, Gilead Sciences, and MSD, outside the submitted work. VC reports personal fees from AbbVie, BMS, Gilead Sciences, and MSD, and grants from BMS, outside the submitted work. MCor reports personal fees from AbbVie, BMS, Boehringer Ingelheim, Biogen Idec, Falk Foundation, Gilead Sciences, Janssen, MSD, Roche Diagnostics, Roche Pharma, and Siemens, outside the submitted work. SD and PJ report personal fees and non-financial support from AbbVie and Gilead Sciences, and personal fees from MSD, outside the submitted work. MHE-S is an advisory board member for Perspectum Diagnostics, and reports grants and non-financial support from Gilead Sciences, and non-financial support from AbbVie and Quadri Pharma, outside the submitted work. RF reports grants, personal fees, and non-financial support from Roche and Gilead Sciences, and personal fees and non-financial support from BMS, outside the submitted work. GBG reports grants and personal fees from Gilead Sciences, outside the submitted work. JG-S reports grants and personal fees from Gilead Sciences, and personal fees from MSD, Abbvie, Janssen, and BMS, outside the submitted work. JGer reports grants and personal fees from AbbVie, Gilead Sciences, Janssen, MSD, BMS, and ViiV Healthcare, outside the submitted work. RG reports grants from New South Wales Ministry of Health and provided project advice regarding viral hepatitis treatment to Gilead Sciences, outside the submitted work. AHa reports unrestricted grants from AbbVie, MSD, Gilead Sciences, BMS, and Novartis, and non-financial support from Gilead Sciences, outside the submitted work; he was also on advisory boards for AbbVie, Gilead Sciences, and BMS. CH reports personal fees from AbbVie, BMS, Gilead Sciences, Janssen, and MSD, outside the submitted work. JJ reports personal fees and non-financial support from Gilead Sciences and AbbVie, and personal fees from Roche and BMS, outside the submitted work. MK reports grants from Roche, Siemens, Hologic, and Boerhinger Ingleheim, outside the submitted work. JVL reports grants and personal fees from Gilead Sciences and personal fees from Cepheid, outside the submitted work. MMan reports personal fees from Roche, BMS, GlaxoSmithKline, Aevi Genomic Medicine, ENYO Pharma, and CureVac, and grants and personal fees from Gilead Sciences and Novartis, outside the submitted work. SMau reports personal fees and non-financial support from Gilead Sciences and BMS, outside the submitted work. CM reports grants and personal fees from AbbVie, Gilead Sciences, and BMS; personal fees from MSD; and grants from Roche, outside the submitted work. BM reports grants and personal fees from Gilead Sciences and personal fees from AbbVie, MSD, BMS, Bayer, Intercept, and Sigma-Tau, during the conduct of the study. FN reports personal fees and non-financial support from Gilead Sciences, during the conduct of the study. AR reports grants and personal fees from AbbVie, Gilead, and MSD, and personal fees form BMS, Celgene, Janssen, Intercept, and Lupin, outside the submitted work. HWR reports grants and personal fees from AbbVie, BMS, Boehringer Ingelheim, ENYO Pharma, Gilead Sciences, Janssen, MSD, PRA Health Sciences, Regulus, and Roche; personal fees from Alnylam and R-Pharm; and grants from Replicor, outside the submitted work. LRR reports grants from the Center for Clinical and Translational Science and the Swedish Research Council (Ghana), during the conduct of the study. LRR also reports grants from Gilead Sciences, BTG, Ariad, and Wako, outside the submitted work, and was a consultant and advisory board member for Wako, Medscape, Axis, OncLive, Bayer, Tavec, and Grail. SDR has served as an advisory board member and speaker for Gilead Sciences, AbbVie, and MSD. OS has served as a consultant and on advisory boards for MSD; received research grants from AbbVie, BMS, MSD, Boehringer Ingelheim, R-Pharm, and Hepatera; and served as a speaker for Abbott, AbbVie, BMS, Gilead Sciences, Janssen, MSD, and R-Pharm. JFS-A reports personal fees from AbbVie and grants from Gilead Sciences and Janssen, outside the submitted work. CSa reports personal fees from Gilead Sciences and BMS, outside the submitted work. PS reports grants and personal fees from Gilead Sciences, AbbVie, and BMS, and personal fees from Intercept, outside the submitted work. CSt has consulted with and served on advisory boards for Gilead Sciences, AbbVie, and MSD. VSy reports grants and personal fees from Gilead Sciences, personal fees and non-financial support from AbbVie, and personal fees from Janssen, outside the submitted work. KT reports grants and personal fees from AbbVie, Gilead Sciences, and BMS; personal fees from MSD and Alfa Wasserman; and grants from Janssen, outside the submitted work. AJvdM reports grants and personal fees from Gilead Sciences and personal fees from AbbVie, outside the submitted work. IW reports personal fees from AbbVie, Gilead Sciences, Janssen, Marcyrl, Mylan, Onxio, and Pharco, outside the submitted work. NW reports personal fees paid to her department from AbbVie, BMS, Gilead Sciences, and MSD, outside the submitted work. VWW reports personal fees from Gilead Sciences, BMS, and MSD, outside the submitted work. M-FY was a speaker or advisory board member for AbbVie, BMS, Gilead Sciences, Roche, GlaxoSmithKline, Fujirebio, Biocartis, and MSD, outside the submitted work. SZ reports consultancy and lecture fees from AbbVie, Gilead Sciences, and MSD, and consultancy fees from Intercept, outside the submitted work. All other authors declare no competing interests., This study was funded by the John C Martin Foundation through the Polaris Observatory. We thank the Research on Hepatitis group (H28-kansei-ippan-001 and H25-kanen-ippan-010; led by JT), funded by the Ministry of Health, Labour and Welfare of Japan, for their provision of country-level data for Japan, and Örebro County Council for providing ALF grants (OLL-683801) to A-SD, which allowed collection of country-level data for Sweden.

Published
2018

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