在持续移民的高收入国家消除乙型肝炎的可行性

StephenW

在持续移民的高收入国家消除乙型肝炎的可行性

    冯天
    乔丹·J·费尔德
    Zeny Feng
    贝特·桑德
    威廉 W.L.黄

发布时间：2022年4月25日DOI：https://doi.org/10.1016/j.jhep.2022.04.014
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强调

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    我们开发了一个基于代理的模型，反映了在移民不断的高收入国家中 HBV 传播的动态。
    •
    当前和扩大的疫苗接种、筛查和治疗策略不足以实现世卫组织的目标。
    •
    迫切需要对 CHB 的可治愈治疗进行进一步的医学研究。
    •
    对于一个移民接收国来说，世卫组织的目标可能并不现实。
    •
    制定移民筛查政策可以减少 HBV 相关并发症。

背景与目标
应对 HBV 对于实现世界卫生组织 (WHO) 的病毒性肝炎消除目标至关重要，因为 47% 的病毒性肝炎并发症可归因于 HBV。本研究的目的是开发一种基于代理的模型，以确定哪些涉及疫苗接种、筛查和治疗的综合策略将实现 WHO 的目标。
方法
我们开发了一个基于代理的模型来描述高收入国家的 HBV 流行情况，这些国家正在进行移民。通过性网络和围产期传播模拟了 HBV 的传播。从文献中估计模型参数并根据历史 HBV 数据进行校准。进行敏感性分析以评估不确定性。
结果
我们预测，在目前的策略下，2015-2030 年间，急性乙型肝炎、HBV 所致失代偿期肝硬化和肝细胞癌的发病率将分别下降 64.5%、9.4% 和 10.5%。然而，2015-2030 年间，慢性乙型肝炎和肝脏相关死亡的发生率将分别增加 26.6% 和 1.0%。结果对移民人数和移民中的 HBV 流行率很敏感。
结论
结果表明，目前的疫苗接种、筛查和治疗策略将不足以实现世卫组织的消除目标。即使在疫苗接种、筛查和治疗方面进行了广泛的综合扩大，发病率和死亡率目标也可能无法实现，这凸显了重新评估全球 HBV 战略的必要性，以及开发针对 HBV 的治愈性疗法的重要性，以及制定量身定制的策略来预防长期后遗症并改善移民的健康状况。
总结
我们开发了一个模型，该模型反映了高收入国家持续移民的乙型肝炎病毒 (HBV) 传播动态，这使我们能够预测 HBV 的流行病学以用于政策层面的决策。我们的分析表明，目前的疫苗接种、筛查和治疗策略不足以实现世卫组织消除慢性乙型肝炎的目标。即使在疫苗接种、筛查和治疗方面广泛综合扩大规模，发病率和死亡率目标也可能无法实现。

StephenW

Feasibility of hepatitis B elimination in high-income countries with ongoing immigration

    Feng Tian
    Jordan J. Feld
    Zeny Feng
    Beate Sander
    William W.L. Wong

Published:April 25, 2022DOI:https://doi.org/10.1016/j.jhep.2022.04.014
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Highlights

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    We developed an agent-based model reflecting the dynamics of HBV transmission in a high-income country with ongoing immigration.
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    Current and scaled-up vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals.
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    Further medical research on curable treatments for CHB is urgently needed.
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    For an immigrant-receiving country, the WHO goals may not be realistic.
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    Formulation of immigration screening policies would allow for a reduction in HBV-related complications.

Background & Aims
Addressing HBV is vital to meeting the World Health Organization (WHO)’s viral hepatitis elimination goals, as 47% of viral hepatitis complications can be attributed to HBV. The objective of this study is to develop an agent-based model determining which integrated strategies involving vaccination, screening, and treatment would achieve the WHO’s goals.
Methods
We developed an agent-based model to characterize the HBV epidemic in a high-income country with ongoing immigration. The spread of HBV was simulated through sexual networks and perinatal transmission. Model parameters were estimated from the literature and calibrated against historical HBV data. Sensitivity analyses were performed to assess the uncertainty.
Results
We predict that under the current strategies, the incidence of acute hepatitis B, and HBV-attributable decompensated cirrhosis and hepatocellular carcinoma would decrease by 64.5%, 9.4%, and 10.5% between 2015–2030, respectively. However, the incidence of chronic hepatitis B and liver-related deaths would increase by 26.6% and 1.0% between 2015–2030, respectively. Results were sensitive to the number of immigrants and HBV prevalence in immigrants.
Conclusions
The results suggest that the current vaccination, screening, and treatment strategies will be inadequate to achieve WHO elimination goals. Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable, highlighting the need for a re-evaluation of the global strategy for HBV, the importance of developing curative therapy for HBV, and of establishing tailored strategies to prevent long-term sequelae and improve health in immigrants.
Lay summary
We have developed a model that reflects the dynamics of hepatitis B virus (HBV) transmission in a high-income country with ongoing immigration, which enabled us to forecast the epidemiology of HBV for policy-level decision making. Our analysis suggests that current vaccination, screening, and treatment strategies are inadequate to achieve the WHO goals of eliminating chronic hepatitis B. Even with extensive integrated scale-up in vaccination, screening, and treatment, the morbidity and mortality targets may not be reachable.