Abstract
The major cause of liver cancer around the globe is hepatitis B virus (HBV), which also contributes to a large number of deaths due to liver failure alone. Hepatitis delta virus (HDV) is as potentially alarming as HBV since life threatening cases are 10 times more likely with HBV-HDV dual infection compared to HBV monoinfection. So far, there is no established effective treatment against HDV and the only preventive action suggested by the World Health Organization is to introduce HBV vaccination for children immediately after birth (newborns) and thus reduce the available pool for HDV infection. Here the main objective is to understand the complex dynamics of HBV-HDV infection in a human population that can inform public health policy makers on the level of different preventive measures required to eliminate HBV and HDV infections. Model simulations suggest that HBV vertical transmission and HBV vaccination rates for newborns are instrumental in determining HBV and HDV prevalence. A decrease in HBV prevalence is observed as vaccination coverage increases and it is possible to eradicate both HBV and HDV using high vaccination coverage of ≥80% in the long term. We further found that HDV presence results in lower HBV prevalence. An application of our model to China revealed that vaccinating every newborn in China will further prevent 1.69 million new infections by 2028 as compared to the current 90% vaccination coverage. Although, higher vaccination coverage of newborns should eliminate both HBV and HDV over a long time period, any short term strategy to eradicate HDV must include additional preventive measures such as HBV adult vaccination. Implementation of HBV adult vaccination programs at a rate of 10% per year over 15 years will further prevent 39 thousand new HDV infections in China by 2028 as compared to HBV vaccination programs solely for newborns.
Highlights
Almost two billion people have been infected with hepatitis B virus (HBV) at some stage of their lives, with 400 million chronically infected
hepatitis delta virus (HDV) infectivity affecting HBV prevalence Since there is uncertainty around the individual transmission probabilities, we investigated the effect of different HDV transmission probabilities on HBV and HDV prevalence in the total population after a time of 100 years assuming 90% HBV vaccination coverage at birth and other parameters as given in Table 1 (Figure 2(A)-(B))
We found that increasing vaccination coverage will have a huge impact on HBV prevalence alone but the introduction of adult vaccination will have the greatest impact on both HBV and HDV prevalence
Summary
Almost two billion people have been infected with hepatitis B virus (HBV) at some stage of their lives, with 400 million chronically infected. 5% (18 million) of HBV infected individuals are infected with hepatitis delta virus (HDV) [6]. Individuals infected with HDV have a high mortality rate of 2–20% in 5–10 years which is ten times higher than for those with HBV monoinfection [7,8,9]. The rate of conversion from acute to the chronic stage of HDV infection is very high, 5 times more than in those with HBV monoinfection [16,17] and the incidence of liver failure is much higher than for individuals with HBV monoinfection. HBV transmission is less likely from someone who is infected with HDV [7,8,18]
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