Abstract
ObjectiveTo conduct a systematic review and meta-analysis of the long-term impact of infant vaccination on the prevalence of hepatitis B virus (HBV) infection at the population level.MethodsWe searched online databases for articles reporting comparisons between population cohorts aged ≥ 15 years who were exposed or unexposed to infant HBV immunization programmes. We categorized programmes as universal or targeted to infants whose mothers were positive for hepatitis B surface antigen (HBsAg). We included studies reporting prevalence of hepatitis B core antibody (HBcAb), HBsAg, or both. We evaluated the quality of the study methods and estimated the relative reduction in the prevalence of infection.FindingsOf 26 studies that met the inclusion criteria, most were from China (20 studies). The prevalence of HBV infection in unvaccinated and universally vaccinated cohorts ranged from 0.6% (116 of 20 305 people) to 16.3% (60/367) and from 0.3% (1/300) to 8.5% (73/857), respectively. Comparing cohorts with universal vaccination to those without vaccination, relative prevalences were 0.24 (95% confidence interval, CI: 0.16–0.35) for HBsAg and 0.23 (95% CI: 0.17–0.32) for HBcAb. For populations with targeted vaccination, relative prevalences were 0.32 (95% CI: 0.24–0.43) and 0.33 (95% CI: 0.23–0.45), respectively.ConclusionThe residual burden of infection in cohorts offered vaccination suggests that longer-term evaluations of vaccination coverage, timeliness and other aspects of programme quality are needed. As HBV-vaccinated infant cohorts reach adulthood, ongoing analysis of prevalence in adolescents and young adults will ensure that elimination efforts are on track.
Highlights
Infection with the hepatitis B virus (HBV) is a major global cause of ill health that affects low- and middleincome countries
A plasma-derived vaccine, first used in a national infant immunization programme in 1984,5 was gradually replaced by recombinant vaccines, which can be manufactured at greater scale
In virtually all studies, unvaccinated cohorts were born in years before the implementation of the newborn vaccination programme or had passed the qualifying age at the time of implementation of catch-up programmes
Summary
Infection with the hepatitis B virus (HBV) is a major global cause of ill health that affects low- and middleincome countries. An estimated 257 million people have chronic HBV infection, and 686 000 deaths occur annually due to long-term complications including liver cirrhosis and hepatocellular carcinoma, a number that is projected to increase.. Most chronic infection is acquired in infancy or early childhood, primarily through mother-to-child transmission.. Through sexual intercourse or blood contact, can lead to chronic infection but more frequently results in viral clearance and immunity. Vaccines against HBV infection are highly effective. The global recommended schedule is a dose at birth, ideally within 24 hours, followed by two to three doses at monthly intervals. A plasma-derived vaccine, first used in a national infant immunization programme in 1984,5 was gradually replaced by recombinant vaccines, which can be manufactured at greater scale. The global recommended schedule is a dose at birth, ideally within 24 hours, followed by two to three doses at monthly intervals.
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