Abstract
Hepatitis B is a global epidemic that requires carefully orchestrated vaccination initiatives in geographical regions of medium to high endemicity to reach the World Health Organization’s elimination targets by 2030. This study compares two widely-used deterministic hepatitis B models—the Imperial HBV model and the CDA Foundation’s PRoGReSs—based on their predicted outcomes in four countries. The impact of scaling up of the timely birth dose of the hepatitis B vaccine is also investigated. The two models predicted largely similar outcomes for the impact of vaccination programmes on the projected numbers of new cases and deaths under high levels of the infant hepatitis B vaccine series. However, scenarios for the scaling up of the infant hepatitis B vaccine series had a larger impact in the PRoGReSs model than in the Imperial model due to the infant vaccine series directly leading to the reduction of perinatal transmission in the PRoGReSs model, but not in the Imperial model. Meanwhile, scaling up of the timely birth dose vaccine had a greater impact on the outcomes of the Imperial hepatitis B model than in the PRoGReSs model due to the greater protection that the birth dose vaccine confers to infants in the Imperial model compared to the PRoGReSs model. These differences underlie the differences in projections made by the models under some circumstances. Both sets of assumptions are consistent with available data and reveal a structural uncertainty that was not apparent in either model in isolation. Those relying on projections from models should consider outputs from both models and this analysis provides further evidence of the benefits of systematic model comparison for enhancing modelling analyses.
Highlights
Hepatitis B virus (HBV), which is spread via infected bodily fluids, causes millions of chronic infections each year
In order to estimate the marginal impact of the scaling up of the timely birth dose, we examined the difference between the projections for scenario II and III, as these differ only in respect of the level of timely birth dose coverage that is assumed
In addition to target coverage values, the World Health Organization (WHO) recommendations include other preventative measures such as blood and injection safety, as well as treatment targets [9], none of which have been included in the current modelling exercise
Summary
Hepatitis B virus (HBV), which is spread via infected bodily fluids, causes millions of chronic infections each year. The primary source of chronic HBV infections is vertical transmission. Comparison of two hepatitis B simulation models and impact of birth dose and Department for International Development (MR/R015600/1; https://www.gov.uk/government/ organisations/department-for-internationaldevelopment). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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