The proportion of children under five years of age chronically infected with the hepatitis B virus (HBV) has dropped to just under 1% in 2019, declining sharply from around 5% during the pre-vaccine era between the 1980s and the early 2000s, according to new estimates released by the World Health Organization (WHO).
This achievement marks the successful realization of a major milestone target established within the United Nations Sustainable Development Goals. Specifically, the global community set out to reach a prevalence of under 1% for chronic HBV infections in children under the age of five by the year 2020. The dramatic reduction represents a watershed moment in modern public health, signalling the profound efficacy of widespread childhood vaccination programmes implemented over the past two decades.
"No infant should grow up only to die of hepatitis B because they were not vaccinated," said Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO. "Today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations. Preventing mother-to-child transmission of hepatitis B is the most important strategy for controlling the disease and saving lives. Even in the midst of the COVID-19 pandemic, we must ensure that mothers and newborns have access to life-saving services including hepatitis B vaccinations."
Marking World Hepatitis Day 2020, the WHO is calling for united and stepped-up action to build upon this historic achievement. Public health officials emphasize the need for intensified efforts to prevent mother-to-child transmission of HBV through expanded routine testing of pregnant women, the provision of antiviral prophylaxis to those who need it, and the consistent maintenance and expansion of access to comprehensive hepatitis B immunization programmes, particularly the timely administration of the birth dose vaccine.
Globally, more than 250 million people currently live with chronic HBV infection. Infants and young children are especially vulnerable to the long-term impacts of the virus. Approximately 90% of children infected with HBV during their first year of life go on to develop chronic HBV carriership. The virus aggressively attacks the liver, leading to severe chronic illnesses, cirrhosis, and claiming the lives of nearly 900,000 people each year around the world.
Preventing Hepatitis B
Infants can be shielded from the ravages of HBV through a safe, highly affordable, and exceptionally effective vaccine that provides over 95% protection against infection. To maximize this protection, the WHO recommends that all infants receive their first dose of the hepatitis B vaccine as soon as possible after birth—preferably within the first 24 hours of life—followed by at least two additional doses to complete the primary series.
The vast scale-up of the hepatitis B vaccine worldwide over the past two decades has served as one of the great public health success stories of modern times. This massive expansion has been driven in large part by the crucial financial and logistical support provided by Gavi, the Vaccine Alliance, which has directly contributed to the steep decline in HBV infections among children. By 2019, global coverage of the complete three-dose series of the hepatitis B vaccine during infancy reached 85%, climbing dramatically from a baseline of around 30% in the year 2000.
Despite these impressive gains in the complete immunization series, access to the critical first dose administered within 24 hours of birth remains stubbornly uneven across different regions of the world. While global coverage of this timely birth dose stands at 43%, regional disparities are stark. Birth dose coverage drops precipitously to 34% in the WHO Eastern Mediterranean Region and plunges to a mere 6% in the WHO African Region, leaving millions of newborns unprotected during their most vulnerable window.
"Expanding access to a timely birth dose of the hepatitis B vaccine is the cornerstone of efforts to prevent mother-to-child transmission of HBV," said Dr Meg Doherty, Director of Global HIV, Hepatitis, and STI Programmes at the WHO. "For countries, especially in regions such as sub-Saharan Africa, where the birth dose of hepatitis B vaccine has not yet been introduced into national immunisation schedules, it is a priority to assure that protection as early as possible."
An additional, powerful method to protect children from vertical transmission is to provide pregnant women diagnosed with high viral loads with antiviral treatment. The WHO already recommends the routine testing of all pregnant women for HBV, alongside routine screenings for HIV and syphilis, as early as possible during pregnancy. In light of accumulating clinical evidence regarding the safety and efficacy of antiviral prophylaxis in pregnant women and their exposed children, the WHO is issuing updated policy recommendations to reinforce these clinical pathways.
In nations that have already achieved high coverage rates for routine childhood hepatitis B immunization—including the timely administration of the birth dose—implementing routine testing for HBV infection among pregnant women and providing antiviral prophylaxis to those who require it offers an additional, highly effective opportunity to halt onward transmission from mother to child.
"Stopping vertical transmission of HBV is a key pillar of the global ‘triple elimination’ initiative, which seeks to eliminate mother-to-child transmission of three infections that are heavily prevalent in low- and middle-income countries: HIV, syphilis, and hepatitis B virus," Dr Doherty added.
Successfully eliminating mother-to-child transmission of HBV also serves as an indispensable stepping stone toward reaching the broader targets outlined in the WHO’s global health sector strategy on viral hepatitis. That strategy aims to reduce new hepatitis infections by 90% and slash hepatitis-related deaths by 65% by 2030, using 2015 levels as the baseline for comparison.
The COVID-19 Pandemic Jeopardizes Future Progress
Even as the global health community celebrates the historic milestone of reducing chronic HBV prevalence among young children to under 1%, the ongoing COVID-19 pandemic threatens to severely hamper future progress. Lockdowns, overburdened health systems, supply chain disruptions, and community hesitancy have placed routine immunization programmes under immense strain.
According to a sobering new modelling study conducted by Imperial College London in close collaboration with the WHO, systemic disruptions to hepatitis B vaccination programmes resulting from the pandemic could have a catastrophic impact on efforts to achieve the ambitious targets of the global strategy.
Under a worst-case scenario featuring high levels of disruption—including a 60% drop in timely birth dose coverage and a 20% reduction in childhood HBV immunization coverage for the duration of a single year—combined with delays and a slow post-pandemic recovery in expanding vaccination programmes toward planned 2030 WHO targets, the projections are alarming. The model estimates there would be an estimated 5.3 million additional chronic HBV infections among children born between the years 2020 and 2030, alongside 1 million additional HBV-related deaths among those same children later in life.
These findings underscore the reality that missed opportunities today in preventing new HBV infections will carry long-lasting, life-impacting consequences for entire generations, reinforcing the urgent need to maintain essential immunization services even amidst global health emergencies.
World Hepatitis Day is commemorated annually on July 28 to enhance global awareness of viral hepatitis, a systemic inflammation of the liver that triggers a diverse spectrum of health complications, ranging from acute infections to cirrhosis and liver cancer. The theme for the global campaign focuses heavily on fostering a "hepatitis-free future," with an intense, dedicated focus on preventing hepatitis B among mothers and newborns.
Medical science recognizes five primary strains of the hepatitis virus, designated as types A, B, C, D, and E. Among these, hepatitis B and hepatitis C together constitute the most devastating burden, accounting for the vast majority of viral hepatitis morbidity and claiming approximately 1.3 million lives globally each year. Even amidst the unprecedented shadow of the COVID-19 pandemic, viral hepatitis continues to claim thousands of lives every single day, reinforcing the necessity of sustained vaccination, testing, and treatment initiatives worldwide.
