Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi.
BACKGROUND
Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce hepatitis-associated mortality, antiviral treatment programmes are needed. We estimated prevalence, vaccine impact and need for antiviral treatment in Blantyre, Malawi to inform an effective public health response.


METHODS
We conducted a household study in Blantyre in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardised HBsAg seroprevalence. Impact of infant hepatitis B vaccination, which began in 2002, was estimated by binomial log-linear regression comparing individuals born before and after vaccine implementation. In HBsAg-positive adults, eligibility for antiviral therapy was assessed.


RESULTS
Of 97,386 censused individuals, 6,073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% CI 4.3-6.1) among adults and 0.3% (0.1-0.6) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (70.3-99.4). Of HBsAg-positive adults, 26% were HIV-positive. Among HIV-negative individuals, 3%, 6% and 9% were eligible for hepatitis B treatment by WHO, European and American hepatology association criteria, respectively.


CONCLUSIONS
Infant HBV vaccination has been highly effective in reducing HBsAg prevalence in urban Malawi. Up to 9% of HBsAg-positive HIV-negative adults are eligible, but have an unmet need, for antiviral therapy.
['Stockdale|Alexander J|AJ|0000-0002-5828-3328', 'Meiring|James E|JE|', 'Shawa|Isaac T|IT|', 'Thindwa|Deus|D|', 'Silungwe|Niza M|NM|', 'Mbewe|Maurice|M|', 'Kachala|Rabson|R|', 'Kreuels|Benno|B|', 'Patel|Pratiksha|P|', 'Patel|Priyanka|P|', 'Henrion|Marc Y R|MYR|', 'Bar-Zeev|Naor|N|', 'Swarthout|Todd D|TD|', 'Heyderman|Robert S|RS|', 'Gordon|Stephen B|SB|', 'Geretti|Anna Maria|AM|', 'Gordon|Melita A|MA|']
Hepatitis B Vaccination Malawi Africa Public Health Antiviral Agents Epidemiology South of the Sahara