Tackling Hepatitis B in the Asia-Pacific Region

Explore the impact of hepatitis B virus (HBV) in Asia-Pacific and progress being made against the disease.

Hepatitis B virus (HBV) infection remains a significant public health challenge, particularly in low- and middle-income countries (LMIC) and in the Asia-Pacific region. Coordinated efforts are needed to combat this disease and improve the clinical status of persons with HBV infection. Currently there is no cure for hepatitis B, however there are several drugs in clinical development to improve the lives and clinical outcomes for persons with chronic HBV infection, including functional cure strategies.

HBV monitoring and updated guidelines

In March 2024, the World Health Organization published updated guidelines on the prevention, diagnosis and treatment of chronic HBV infection. These guidelines aim to simplify treatment criteria and expand eligibility for antiviral prophylaxis, especially for pregnant women to prevent mother-to-child transmission of HBV. The new guidelines emphasize the importance of early diagnosis and treatment to reduce the disease burden and improve patient outcomes.

The “Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries” provides a comprehensive overview of the hepatitis B and C burden worldwide, highlighting the progress made toward increasing access to essential viral hepatitis services and challenges that still remain. It underscores the need for continued efforts to improve access to diagnostics, treatment and preventive measures in low- and middle-income countries.

HBV impact and prevalence in Asia-Pacific region

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The Asia-Pacific region bears a disproportionate burden of HBV infection, with millions of people affected. Because there are no symptoms initially and HBV is not routinely screened for, most of these cases are “silent” until middle age. The majority of cases of chronic HBV infection are acquired perinatally, from mother to child. Given immunization practices in Asia-Pacific, cases are not identified early so HBV infection has greater time to progress to chronic HBV.

The Asia-Pacific region has one of the highest prevalence rates of HBV infection globally. Key statistics include:

• Approximately 75% of the world’s chronic HBV carriers reside in Asia-Pacific.
• Countries such as China, India and Indonesia have particularly high prevalence rates.
• Vertical transmission (from mother to child) and horizontal transmission (through contact with infected blood) are common routes of infection. However, HBV is also transmitted sexually and with exposure to blood, as in needle sharing with drug use.

Burden of disease

Hepatitis B contributes significantly to liver-related morbidity and mortality in Asia-Pacific. Key points include:

• Chronic HBV infection can lead to liver cirrhosis, hepatocellular carcinoma (HCC), liver failure and death.
• The economic burden includes health care costs, loss of productivity and social stigma associated with the disease.

Hepatitis B prevalence in China

A systematic review and meta-analysis published in BMC Infectious Diseases in February 2024 examined the prevalence of hepatitis B in the Chinese general population from 2018 to 2022. The study found that the pooled prevalence of HBV infection was 3%, with higher rates in rural areas compared to urban areas. This data is crucial for informing public health strategies and targeting interventions to reduce the prevalence of HBV in China.

Putting strategy into action in fight against HVB in Asia-Pacific

Expanded screening and regional efforts

Expanded screening for chronic hepatitis B virus infection in China has been a critical step in identifying and treating more individuals with HBV. Various initiatives in the Asia-Pacific region have taken aim at addressing this public health emergency. Guidelines from the Asian Pacific Association for the Study of the Liver (APASL) also provide valuable insights into managing HBV, particularly in pregnant women.

Prevention and control

Effective strategies for preventing and controlling HBV infection in Asia-Pacific include:

• Vaccination: Universal infant vaccination programs have been successful in reducing HBV transmission.
• Screening and diagnosis: Early detection through screening programs is crucial for managing and preventing complications.
• Public awareness: Education campaigns to raise awareness about HBV transmission and prevention.

Management and treatment

Advances in antiviral therapies have improved the prognosis for individuals with chronic HBV infection. Key aspects include:

• Antiviral treatment: Medications known as nucleoside analogs, such as tenofovir and entecavir, are effective in suppressing viral replication. While they do not eradicate the virus from the bloodstream, they do help to keep the virus suppressed, so that persons with HBV infection will not remain infectious to others, and disease progression is ameliorated.
• Monitoring and follow-up: Regular monitoring of liver function and viral load is essential for managing chronic HBV infection.
• Access to care: Ensuring access to affordable and effective treatment remains a challenge in many Asia-Pacific countries.

Case studies and real-world examples

• China’s vaccination success: China has implemented a robust HBV vaccination program, significantly reducing the prevalence of HBV among children. A study showed that the prevalence of HBV surface antigen (HBsAg) among children under 5 years old decreased from 9.67% in 1992 to 0.32% in 2014. This success is attributed to the integration of the HBV vaccine into the national immunization program.
• Mother-to-child transmission prevention in Taiwan: Taiwan has been a pioneer in preventing mother-to-child transmission of HBV. The country introduced a nationwide HBV vaccination program for newborns in 1984. As a result, the HBsAg carrier rate among children decreased from 10% to less than 1%. This program includes administering the first dose of the HBV vaccine within 24 hours of birth, followed by additional doses and hepatitis B immunoglobulin for infants born to HBsAg-positive mothers.
• Community-based screening in Vietnam: In Vietnam, community-based screening programs have been effective in identifying HBV carriers and providing early treatment. A project in Ho Chi Minh City screened more than 10,000 individuals, identifying 8% as HBsAg-positive. These individuals received counseling and were referred for further medical evaluation and treatment, highlighting the importance of community engagement in HBV management.

Challenges in Asia-Pacific remain, but further progress is possible

Despite progress, several challenges remain in the fight against HBV in Asia-Pacific:

• Health care infrastructure: Limited resources and infrastructure in some countries hinder effective HBV management.
• Stigma and discrimination: Social stigma associated with HBV infection can prevent individuals from seeking diagnosis and treatment.
• Research and innovation: Continued research is needed to develop better vaccines, treatments and diagnostic tools. Currently, there is an enormous push from companies that manufacture antiviral drugs, governments, public health agencies, physicians/scientists and other vested groups to find a functional cure for HBV infection. This will likely be achieved with combinations of drugs and perhaps immune therapies to stimulate one’s immune system to fight the infection.

Addressing the hepatitis B epidemic in the Asia-Pacific region requires a multifaceted approach involving governments, health care providers and communities. By strengthening prevention, improving access to care and reducing stigma, we can make significant strides in combating this public health threat.

Keys to successfully addressing HBV in Asia-Pacific

• Expand vaccination programs: Ensure universal infant vaccination and consider catch-up vaccination for older age groups.
• Enhance screening and diagnosis: Implement widespread screening programs to identify and manage HBV infections early.
• Improve access to treatment: Increase availability and affordability of antiviral therapies.
• Raise public awareness: Conduct education campaigns to reduce stigma and promote preventive measures.
• Invest in research: Support research initiatives to develop new vaccines, treatments and diagnostic tools.

Specialized infectious disease expertise is a must

Understanding the nuances and complexities of infectious disease research is vital for success. Our proven track record of success with HBV clinical trials is just one example of our deep expertise in infectious disease research. Partner with the PPD™ clinical research business of Thermo Fisher Scientific to gain access to our subject matter experts across a broad range of infectious disease indications. Our end-to-end global capabilities — including site networks and investigators, regulatory support, integrated laboratory services, patient access, and digital and decentralized solutions — support your study from Phase I through peri-and post-approval.