@article{3123359,
    title = "Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study",
    author = "Razavi-Shearer, D. and Gamkrelidze, I. and Nguyen, M.H. and Chen, D.-S. and Van Damme, P. and Abbas, Z. and Abdulla, M. and Abou Rached, A. and Adda, D. and Aho, I. and Akarca, U. and Al Ali, F.H. and Lawati, F.A.L. and Naamani, K.A.L. and Alashgar, H.I. and Alavian, S.M. and Alawadhi, S. and Albillos, A. and Al-Busafi, S.A. and Aleman, S. and Alfaleh, F.Z. and Aljumah, A.A. and Anand, A.C. and Anh, N.T. and Arends, J.E. and Arkkila, P. and Athanasakis, K. and Bane, A. and Ben-Ari, Z. and Berg, T. and Bizri, A.R. and Blach, S. and Brandão Mello, C.E. and Brandon, S.M. and Bright, B. and Bruggmann, P. and Brunetto, M. and Buti, M. and Chan, H.L.Y. and Chaudhry, A. and Chien, R.-N. and Choi, M.S. and Christensen, P.B. and Chuang, W.-L. and Chulanov, V. and Clausen, M.R. and Colombo, M. and Cornberg, M. and Cowie, B. and Craxi, A. and Croes, E.A. and Cuellar, D.A. and Cunningham, C. and Desalegn, H. and Drazilova, S. and Duberg, A.-S. and Egeonu, S.S. and El-Sayed, M.H. and Estes, C. and Falconer, K. and Ferraz, M.L.G. and Ferreira, P.R. and Flisiak, R. and Frankova, S. and Gaeta, G.B. and García-Samaniego, J. and Genov, J. and Gerstoft, J. and Goldis, A. and Gountas, I. and Gray, R. and Guimarães Pessôa, M. and Hajarizadeh, B. and Hatzakis, A. and Hézode, C. and Himatt, S.M. and Hoepelman, A. and Hrstic, I. and Hui, Y.-T.T. and Husa, P. and Jahis, R. and Janjua, N.Z. and Jarcuška, P. and Jaroszewicz, J. and Kaymakoglu, S. and Kershenobich, D. and Kondili, L.A. and Konysbekova, A. and Krajden, M. and Kristian, P. and Laleman, W. and Lao, W.-C.C. and Layden, J. and Lazarus, J.V. and Lee, M.-H. and Liakina, V. and Lim, Y.-S.S. and Loo, C.-K.K. and Lukšic, B. and Malekzadeh, R. and Malu, A.O. and Mamatkulov, A. and Manns, M. and Marinho, R.T. and Maticic, M. and Mauss, S. and Memon, M.S. and Mendes Correa, M.C. and Mendez-Sanchez, N. and Merat, S. and Metwally, A.M. and Mohamed, R. and Mokhbat, J.E. and Moreno, C. and Mossong, J. and Mourad, F.H. and Müllhaupt, B. and Murphy, K. and Musabaev, E. and Nawaz, A. and Nde, H.M. and Negro, F. and Nersesov, A. and Nguyen, V.T.T. and Njouom, R. and Ntagirabiri, R. and Nurmatov, Z. and Obekpa, S. and Ocama, P. and Oguche, S. and Omede, O. and Omuemu, C. and Opare-Sem, O. and Opio, C.K. and Örmeci, N. and Papatheodoridis, G. and Pasini, K. and Pimenov, N. and Poustchi, H. and Quang, T.D. and Qureshi, H. and Ramji, A. and Razavi-Shearer, K. and Redae, B. and Reesink, H.W. and Rios, C.Y. and Rjaskova, G. and Robbins, S. and Roberts, L.R. and Roberts, S.K. and Ryder, S.D. and Safadi, R. and Sagalova, O. and Salupere, R. and Sanai, F.M. and Sanchez-Avila, J.F. and Saraswat, V. and Sarrazin, C. and Schmelzer, J.D. and Schréter, I. and Scott, J. and Seguin-Devaux, C. and Shah, S.R. and Sharara, A.I. and Sharma, M. and Shiha, G.E. and Shin, T. and Sievert, W. and Sperl, J. and Stärkel, P. and Stedman, C. and Sypsa, V. and Tacke, F. and Tan, S.S. and Tanaka, J. and Tomasiewicz, K. and Urbanek, P. and van der Meer, A.J. and Van Vlierberghe, H. and Vella, S. and Vince, A. and Waheed, Y. and Waked, I. and Walsh, N. and Weis, N. and Wong, V.W. and Woodring, J. and Yaghi, C. and Yang, H.-I. and Yang, C.-L. and Yesmembetov, K. and Yosry, A. and Yuen, M.-F. and Yusuf, M.A.M. and Zeuzem, S. and Razavi, H. and The Polaris Observatory Collaborators",
    journal = "The Lancet Gastroenterology and Hepatology",
    year = "2018",
    volume = "3",
    number = "6",
    pages = "383-403",
    publisher = "Elsevier Ireland Ltd",
    doi = "10.1016/S2468-1253(18)30056-6",
    keywords = "hepatitis B antibody;  hepatitis B surface antigen;  hepatitis B vaccine;  antivirus agent;  virus vaccine, antiviral therapy;  Article;  Delphi study;  disease exacerbation;  enzyme linked immunosorbent assay;  hepatitis B;  human;  infection prevention;  major clinical study;  mother to child transmission;  pregnant woman;  prevalence;  priority journal;  sensitivity analysis;  vaccination;  virus load;  virus transmission;  adult;  blood;  chronic hepatitis B;  global health;  mass immunization;  preschool child;  prevention and control;  transmission;  vertical transmission, Adult;  Antiviral Agents;  Child, Preschool;  Delphi Technique;  Global Health;  Hepatitis B Surface Antigens;  Hepatitis B, Chronic;  Humans;  Infectious Disease Transmission, Vertical;  Mass Vaccination;  Prevalence;  Viral Vaccines",
    abstract = "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"
}