Abstract
Nearly 257 million individuals have contracted hepatitis B infection around the world. However, only 10% of them know about their illness. Mother to child transmission, nosocomial spread, and sexual transmission are the major etiological factors. Finding the missing millions is a global issue. Hepatitis B care is more difficult compared to hepatitis C as not all patients require treatment and the selection of patients is not straightforward. To eliminate hepatitis B infection, the program should screen pregnant women and start antiviral therapy from the 28th week of pregnancy if hepatitis B virus (HBV) DNA≥ 200,000 IU/mL or hepatitis B e-antigen (HBeAg) reactive. Prevention of perinatal infection, birth dose and neonatal vaccination, post-vaccination monitoring of high-risk groups, catch-up vaccination, and registration of the carriers should be an integral part of the program. Continuum of care is important when planning the elimination program from addressing the risk factors, testing, and referral for treatment. The program should integrate test and treat hepatitis services with existing local health care services. There is a need to create the right environment, raise awareness, remove stigma, and increase screening of those at risk and manage those who require treatment. A national policy should be prepared for capacity building, fund allocation, and implementation strategies. Micro-elimination strategies should boost national elimination effects. Guidelines to diagnose and treat patients with hepatitis B should be simplified. Surveillance should be done to monitor progress, and determine the impact of the elimination program on incidence and mortality, and services.
Highlights
BackgroundWorldwide, about 257 million persons have been exposed to hepatitis B (2015 estimates)
Prevention of perinatal infection, birth dose and neonatal vaccination, post-vaccination monitoring of high-risk groups, catch-up vaccination, and registration of the carriers should be an integral part of the program
WHO goals for viral hepatitis elimination In May 2016, the WHO Global Health assembly released its goals to eliminate viral hepatitis as a major public health threat by 2030 [5]
Summary
About 257 million persons have been exposed to hepatitis B (2015 estimates). Micro-elimination strategies target individual population segments for which treatment and prevention interventions can be delivered quicker and more efficiently These programs may address districts with high prevalence, identify pockets of high prevalence within districts, take measures to prevent transmission or address risk factors, and identify target groups to treat infection and prevent transmission. These programs may focus on antenatal screening, infant vaccination, catch-up vaccination, vaccination of persons who inject drugs, prisoners, decompensated cirrhosis, veterans, or patients with haemophilia and homosexuals It has been shown by creating a lifetime Markov model that strategies to vaccinate, prevent or treat CHB in high-risk populations result in a significant reduction in cirrhosis, decompensation, liver cancer, and chronic hepatitis death with the intervention compared to no intervention [21]. Modelling may be used to estimate incidence when doing surveys is not possible
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