title: Requirements for global elimination of hepatitis B: a modelling study.
abstract: BACKGROUND
  Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them.
  
  
  METHODS
  We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic.
  
  
  RESULTS
  Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed.
  
  
  CONCLUSIONS
  Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis.
  
  
  BACKGROUND
  Medical Research Council.
authors.affiliation: Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK. Electronic address: s.nayagam01@imperial.ac.uk.
authors.forename: Shevanthi
authors.initials: S
authors.lastname: Nayagam
authors.affiliation: Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Thursz
authors.affiliation: Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
authors.affiliation: Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: Lesong
authors.initials: L
authors.lastname: Conteh
authors.affiliation: Global Hepatitis and HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wiktor
authors.affiliation: Global Hepatitis and HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Low-Beer
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D014943:Global Health; D006297:Health Services Accessibility; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening; D015233:Models, Statistical; D015995:Prevalence; D014611:Vaccination / Q000379:methods*
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines