51. Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi.
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Stockdale, Alexander J, Meiring, James E, Shawa, Isaac T, Thindwa, Deus, Silungwe, Niza M, Mbewe, Maurice, Kachala, Rabson, Kreuels, Benno, Patel, Pratiksha, Patel, Priyanka, Henrion, Marc Y R, Bar-Zeev, Naor, Swarthout, Todd D, Heyderman, Robert S, Gordon, Stephen B, Geretti, Anna Maria, Gordon, Melita A, and Maria Geretti, Anna
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HIV infection epidemiology , *HEPATITIS B prevention , *HEPATITIS B , *HIV infections , *VIRAL antigens , *IMMUNIZATION , *HEPATITIS viruses , *ANTIVIRAL agents , *RESEARCH funding , *HEPATITIS B vaccines , *EPIDEMIOLOGICAL research - Abstract
Background: Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce mortality, antiviral treatment programs are needed. We estimated prevalence, vaccine impact, and need for antiviral treatment in Blantyre, Malawi.Methods: We conducted a household study in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardized hepatitis B surface antigen (HBsAg) seroprevalence. Impact of infant hepatitis B vaccination was estimated by binomial log-linear regression comparing individuals born before and after vaccine implementation. In HBsAg-positive adults, eligibility for antiviral therapy was assessed.Results: Of 97386 censused individuals, 6073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% confidence interval [CI], 4.3%-6.1%) among adults and 0.3% (95% CI, .1%-.6%) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (95% CI, 70.3%-99.4%). Of HBsAg-positive adults, 26% were HIV-positive. Among HIV-negative individuals, 3%, 6%, and 9% were eligible for hepatitis B treatment by WHO, European, and American hepatology association criteria, respectively.Conclusions: Infant HBV vaccination has been highly effective in reducing HBsAg prevalence in urban Malawi. Up to 9% of HBsAg-positive HIV-negative adults are eligible, but have an unmet need, for antiviral therapy. [ABSTRACT FROM AUTHOR]- Published
- 2022
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