Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi

J Infect Dis. 2022 Sep 13;226(5):871-880. doi: 10.1093/infdis/jiab562.


Background: Hepatitis B is the leading cause of cirrhosis and liver cancer in sub-Saharan Africa. To reduce mortality, antiviral treatment programs are needed. We estimated prevalence, vaccine impact, and need for antiviral treatment in Blantyre, Malawi.

Methods: We conducted a household study in 2016-2018. We selected individuals from a census using random sampling and estimated age-sex-standardized hepatitis B surface antigen (HBsAg) seroprevalence. Impact of infant hepatitis B vaccination was estimated by binomial log-linear regression comparing individuals born before and after vaccine implementation. In HBsAg-positive adults, eligibility for antiviral therapy was assessed.

Results: Of 97386 censused individuals, 6073 (median age 18 years; 56.7% female) were sampled. HBsAg seroprevalence was 5.1% (95% confidence interval [CI], 4.3%-6.1%) among adults and 0.3% (95% CI, .1%-.6%) among children born after vaccine introduction. Estimated vaccine impact was 95.8% (95% CI, 70.3%-99.4%). Of HBsAg-positive adults, 26% were HIV-positive. Among HIV-negative individuals, 3%, 6%, and 9% were eligible for hepatitis B treatment by WHO, European, and American hepatology association criteria, respectively.

Conclusions: Infant HBV vaccination has been highly effective in reducing HBsAg prevalence in urban Malawi. Up to 9% of HBsAg-positive HIV-negative adults are eligible, but have an unmet need, for antiviral therapy.

Keywords: Africa; Malawi; antiviral agents; epidemiology; hepatitis B; public health; south of the Sahara; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antiviral Agents / therapeutic use
  • Child
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines / therapeutic use
  • Hepatitis B virus
  • Hepatitis B* / drug therapy
  • Hepatitis B* / epidemiology
  • Hepatitis B* / prevention & control
  • Humans
  • Infant
  • Malawi / epidemiology
  • Male
  • Seroepidemiologic Studies
  • Vaccination


  • Antiviral Agents
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines