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      The global impact of the COVID-19 pandemic on the prevention, diagnosis and treatment of hepatitis B virus (HBV) infection

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          Abstract

          The COVID-19 pandemic caused by the SARS-CoV-2 virus has resulted in a myriad of interventions with the urgent aim of reducing the public health impact of this virus. However, a wealth of evidence both from high-income and low-income countries is accruing on the broader consequences of such interventions on economic and public health inequalities, as well as on pre-existing programmes targeting endemic pathogens. We provide an overview of the impact of the ongoing COVID-19 pandemic on hepatitis B virus (HBV) programmes globally, focusing on the possible consequences for prevention, diagnosis and treatment. Ongoing disruptions to infrastructure, supply chains, services and interventions for HBV are likely to contribute disproportionately to the short-term incidence of chronic hepatitis B, providing a long-term source of onward transmission to future generations that threatens progress towards the 2030 elimination goals.

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          Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study

          Joël Mossong, Homie Razavi, Stefan Zeuzem … (2018)
          The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment.
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            Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020

            Jeanne Santoli, Megan C Lindley, Malini B. DeSilva … (2020)
            On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S. health care system's ability to continue providing routine preventive and other nonemergency care. In addition, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities (3). On March 24, CDC posted guidance emphasizing the importance of routine well child care and immunization, particularly for children aged ≤24 months, when many childhood vaccines are recommended.
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              Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study

              Thomas Marjot, Andrew M. Moon, Jonathan A Cook … (2020)
              Background Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation leading to concerns that these patients may be at risk of adverse outcomes following SARS-CoV-2 infection. However, the impact of COVID-19 among patients with pre-existing liver disease remains ill-defined. Methods Data for CLD patients with SARS-CoV-2 were collected by two international registries. Comparisons were made with non-CLD patients with SARS-CoV-2 from a UK hospital network. Results Between 25th March and 8th July 2020, 745 CLD patients were reported from 29 countries including 386 with cirrhosis and 359 without. Mortality was 32% in patients with cirrhosis compared with 8% in those without (p<0.001). Mortality in cirrhosis patients increased according to Child-Turcotte-Pugh class (CTP-A (19%), CTP-B (35%), CTP-C (51%)) and the main cause of death was respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (OR 1.02; 1.01–1.04), CTP-A (OR 1.90; 1.03–3.52), CTP-B (OR 4.14; 2.4–7.65), CTP-C cirrhosis (OR 9.32; 4.80–18.08) and alcohol related liver disease (ALD) (OR 1.79; 1.03–3.13). When comparing CLD versus non-CLD (n=620) in propensity-score-matched analysis there were significant increases in mortality with CTP-B +20.0% (8.8%–31.3%) and CTP-C cirrhosis +38.1% (27.1%–49.2%). Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of which 21% had no respiratory symptoms. 50% of those with hepatic decompensation had acute-on-chronic liver failure. Conclusions This is the largest reported cohort of CLD and cirrhosis patients with SARS-CoV-2 infection to date. We demonstrate that baseline liver disease stage and ALD are independent risk factor for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Glob Health
                Journal ID (iso-abbrev): BMJ Glob Health
                Journal ID (hwp): bmjgh
                Journal ID (publisher-id): bmjgh
                Title: BMJ Global Health
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2059-7908
                Publication date Collection: 2021
                Publication date (Electronic): 5 January 2021
                Volume: 6
                Issue: 1
                Electronic Location Identifier: e004275
                Affiliations
                [1 ]departmentSchool of Clinical Medicine , University of Cambridge School of Clinical Medicine , Cambridge, UK
                [2 ]departmentNuffield Department of Medicine, Medawar Building for Pathogen Research , University of Oxford , Oxford, UK
                [3 ]departmentDepartment of Microbiology and Infectious Diseases , Oxford University Hospitals NHS Foundation Trust , Oxford, UK
                [4 ]departmentDepartment of Zoology , University of Oxford , Oxford, UK
                Author notes
                [Correspondence to ] Dr José Lourenço; jose.lourenco@ 123456zoo.ox.ac.uk
                Author information
                http://orcid.org/0000-0003-2611-1262
                http://orcid.org/0000-0002-9318-2581
                Article
                Publisher ID: bmjgh-2020-004275
                DOI: 10.1136/bmjgh-2020-004275
                PMC ID: 7786543
                PubMed ID: 33402334
                SO-VID: f2348d5a-ac8b-4136-b914-1912b0089724
                Copyright © © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 21 October 2020
                Date revision received : 07 December 2020
                Date accepted : 09 December 2020
                Funding
                Funded by: Department of Zoology, University of Oxford;
                Award ID: Lectureship in Infectious Diseases
                Funded by: Wellcome intermediate fellowship;
                Award ID: 110110/Z/15/Z
                Categories
                Subject: Analysis
                Subject: 1506
                Subject: 2474
                Custom metadata
                special-feature unlocked

                Keywords: viral hepatitis,sars,public health,prevention strategies
                Data availability:
                Keywords: viral hepatitis, sars, public health, prevention strategies

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