Epidemiology of hepatitis B in African countries
In African countries, hepatitis B is the principal cause of liver disease. Deaths from liver disease are rising. Death from hepatitis B is entirely preventable if it is diagnosed and treatment is started in time.
Globally, 296 million people are living with chronic hepatitis B, 2 billion have been exposed, and an estimated 1.5 million people are newly infected each year, making it one of the most widely distributed infectious diseases on earth.[1] Almost two thirds of these new infections occur in the WHO African region (see map), where an estimated 990,000 new infections occur each year. [1] An estimated 80,000 people die in the region every year.
In the WHO African region, 6.5% of people have chronic hepatitis B infection, which is the second highest regional prevalence in the world.[2] Among children less than five years, the prevalence was estimated at 2.7% in the African region, the highest in the world.[2]
The World Health Organisation set several targets for control of hepatitis in 2016. These include a reduction in death from viral hepatitis of 65%, and a reduction in incidence (new cases) of 90% by 2030, and a prevalence among children <5 years of <0.1%.
More specific targets aim for 90% coverage of hepatitis B vaccination and prevention of mother to child transmission programmes by 2030, 90% of people with hepatitis B being diagnosed, and 80% of eligible people receiving treatment.
At the moment, we are far away from attaining these goals.
In the WHO Africa region in 2019, an estimated 2% of people infected were diagnosed and aware of their infection, while an estimated 0.1% of people were treated. [1]
To improve this situation the following priority action is required:
To obtain improved data on the epidemiology of hepatitis B: in communities, in specific populations at risk and in patients with liver disease, to properly understand and track the impact of hepatitis B.
To widen access to diagnosis for people with hepatitis B, before they develop liver disease. This will require an expansion of community testing.
To roll out treatment in decentralised clinics, using simplified criteria for starting treatment, that enables patients to easily access treatment near where they live.
To improve delivery of the hepatitis B vaccine at birth, and innovations to improve delivery of antiviral treatment for pregnant women at risk of transmission to their children.
HEPSANET is working to tackle these objectives- we aim to address the most pressing needs for patients with hepatitis B and to prevent transmission. We aim to improve understanding of these disease and its natural history in Africa, improve the quality of epidemiological data and improve diagnosis and treatment.
[1] WHO Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021
Author:
Dr Alexander Stockdale, Senior Clinical Lecturer, University of Liverpool, United Kingdom and Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi