A mathematical model to estimate global hepatitis B disease burden and vaccination impact.
BACKGROUND
Limited data are available regarding global hepatitis B virus (HBV)-related morbidity and mortality and potential reduction in disease burden from hepatitis B vaccination.


METHODS
A model was developed to calculate the age-specific risk of acquiring HBV infection, acute hepatitis B (illness and death), and progression to chronic HBV infection. HBV-related deaths among chronically infected persons were determined from HBV-related cirrhosis and hepatocellular carcinoma (HCC) mortality curves, adjusted for background mortality. The effect of hepatitis B vaccination was calculated from vaccine efficacy and vaccination series coverage, with and without administration of the first dose of vaccine within 24 h of birth (i.e. birth dose) to prevent perinatal HBV infection.


RESULTS
For the year 2000, the model estimated 620,000 persons died worldwide from HBV-related causes: 580,000 (94%) from chronic infection-related cirrhosis and HCC and 40,000 (6%) from acute hepatitis B. In the surviving birth cohort for the year 2000, the model estimated that without vaccination, 64.8 million would become HBV-infected and 1.4 million would die from HBV-related disease. Infections acquired during the perinatal period, in early childhood (<5 years old), and > or = 5 years of age accounted for 21, 48, and 31% of deaths, respectively. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths.


CONCLUSIONS
Globally, most HBV-related deaths result from the chronic sequelae of infection acquired in the perinatal and early childhood periods. Inclusion of hepatitis B vaccine into national infant immunization programs could prevent >80% of HBV-related deaths.
Goldstein
Susan T
ST
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sgoldstein@cdc.gov
Zhou
Fangjun
F
Hadler
Stephen C
SC
Bell
Beth P
BP
Mast
Eric E
EE
Margolis
Harold S
HS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000821:virology; D002648:Child; D002675:Child, Preschool; D014943:Global Health; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D017325:Hepatitis B Vaccines; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000401:mortality / Q000821:virology; D008113:Liver Neoplasms / Q000401:mortality / Q000821:virology; D008875:Middle Aged; D008954:Models, Biological; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014611:Vaccination
D017325:Hepatitis B Vaccines