A mathematical model to estimate global hepatitis B disease burden and vaccination impact

Int J Epidemiol. 2005 Dec;34(6):1329-39. doi: 10.1093/ije/dyi206. Epub 2005 Oct 25.


Background: Limited data are available regarding global hepatitis B virus (HBV)-related morbidity and mortality and potential reduction in disease burden from hepatitis B vaccination.

Methods: A model was developed to calculate the age-specific risk of acquiring HBV infection, acute hepatitis B (illness and death), and progression to chronic HBV infection. HBV-related deaths among chronically infected persons were determined from HBV-related cirrhosis and hepatocellular carcinoma (HCC) mortality curves, adjusted for background mortality. The effect of hepatitis B vaccination was calculated from vaccine efficacy and vaccination series coverage, with and without administration of the first dose of vaccine within 24 h of birth (i.e. birth dose) to prevent perinatal HBV infection.

Results: For the year 2000, the model estimated 620,000 persons died worldwide from HBV-related causes: 580,000 (94%) from chronic infection-related cirrhosis and HCC and 40,000 (6%) from acute hepatitis B. In the surviving birth cohort for the year 2000, the model estimated that without vaccination, 64.8 million would become HBV-infected and 1.4 million would die from HBV-related disease. Infections acquired during the perinatal period, in early childhood (<5 years old), and > or = 5 years of age accounted for 21, 48, and 31% of deaths, respectively. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths.

Conclusion: Globally, most HBV-related deaths result from the chronic sequelae of infection acquired in the perinatal and early childhood periods. Inclusion of hepatitis B vaccine into national infant immunization programs could prevent >80% of HBV-related deaths.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / virology
  • Child
  • Child, Preschool
  • Global Health
  • Hepatitis B / complications
  • Hepatitis B / epidemiology*
  • Hepatitis B / prevention & control*
  • Hepatitis B Vaccines*
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / epidemiology
  • Hepatitis B, Chronic / prevention & control
  • Humans
  • Immunization Programs
  • Infant
  • Infant, Newborn
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / virology
  • Liver Neoplasms / mortality
  • Liver Neoplasms / virology
  • Middle Aged
  • Models, Biological*
  • Risk Assessment
  • Sensitivity and Specificity
  • Treatment Outcome
  • Vaccination


  • Hepatitis B Vaccines