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Screening, treatment access crucial for eliminating Hep B by 2030, says journal

The World Health Organization's targets for getting rid of the hepatitis B virus were unlikely to be achieved by 2030 unless screening and treatment was made more accessible, according to a report published in The Lancet Gastroenterology & Hepatology.

In 2016 about 300 million people were living with the hepatitis B virus, or HBV, but only 1 in 20, or 5%, of the eligible patients were getting treated. And about 90% of people with the virus were undiagnosed, the report said.

Less than 1% of HBV-infected expectant mothers, who are at high risk of passing the virus on to their children and are the main source of the ongoing epidemic, were receiving the appropriate treatment, the report, by researchers at the Polaris Observatory — an initiative of the Lafayette, Colo.-based Center for Disease Analysis Foundation — said.

By analyzing data from 435 studies the researchers found that progress had been made in controlling the infection worldwide. In 2016, updated estimates showed that about 292 million people were living with the virus, while previously about 364 million had it.

In 2016, 21 countries accounted for more than 80% of all HBV infections, and of these China, India, Nigeria, Indonesia, and Philippines accounted for over 57% of all infected people.

The report said that the virus is most common in East Asia and sub-Saharan Africa.

Undiagnosed HBV

Even though HBV tests to diagnose the virus are available, just 1 in 10, or about 29 million people, globally had been diagnosed by 2016. In the U.S. about two-thirds of those with HBV and 4 out of 5 in the U.K. were unaware of their infection. This shows that diagnosis is not "just a problem in low- and middle-income countries."

However, there has been progress in vaccinating babies, with 2016 data showing that 87% of infants had received the three vaccine doses necessary to prevent the disease.

But less than half of the babies received their first vaccination within 24 hours of birth, and only 1 in 10 babies born to HBV-infected mothers were receiving Hepatitis B immune globulin, used for preventing the development of the virus, along with the full vaccination schedule.

Homie Razavi, from the Center for Disease Analysis Foundation, said that "most mother-to-child transmission occurs within days of birth, so the birth dose is vital."

China increases birth-dose coverage

The report said that 10 out of the 16 countries which accounted for more than 80% of infections among 5-year-olds have not introduced universal birth dose vaccination. And out the of the 16 only China scaled-up timely birth-dose coverage to 90%.

In China, according to 2017 estimates from a Dec. 5, 2017, Jefferies note, the number of people infected with the virus is estimated to be about 80.7 million, and about 25 million had developed chronic hepatitis B.

Sino Biopharmaceutical Ltd.'s Qingzhong, a generic of Gilead Sciences Inc. and GlaxoSmithKline PLC's hepatitis B drug Viread, was approved by the China Food and Drug Administration and will add to the competition in the Chinese market.

Viread, also known as tenofovir disoproxil, has a spot on on China's national reimbursement drug list.

Geoffrey Dusheiko and Kosh Agarwal from the UCL Medical School and Kings College Hospital of London, respectively, said in a linked comment that governments, in regions where the virus prevalence is high, have accepted the "doctrine of vaccination, but have overlooked the larger picture of screening, diagnosis, and treatment to prevent progression."

Razavi said the analysis showed there was "an enormous opportunity for effective screening, diagnosis, and treatment" and this should help to "substantially reduce the numbers of new infections in all countries by 2030."