Over the past years, global efforts have worked to curb the transmission of hepatitis B virus (HBV), particularly in areas with limited healthcare infrastructure.
However, the ongoing coronavirus disease 2019 (COVID-19) pandemic has largely disrupted such programs focused on prevention, diagnosis, and treatment.
The Sustainable Development Goals has aimed to eliminate HBV infection as a public health threat by the year 2030, yet these disruptions appear to make such a goal less likely.
In their recent article, Caitlin Pley, BA, University of Cambridge School of Clinical Medicine, and colleagues assessed the pandemic’s global impact on HBV programs and mitigation efforts.
“Evidence of the effect of the COVID-19 pandemic on the estimated 290 million people living with chronic HBV worldwide has progressively accrued from primary research studies using physician surveys and routine health system data, with reports that approximately 90% of viral hepatitis services have been disrupted during the COVID-19 pandemic,” they wrote.
Pley and team noted that the preliminary data from the Institute for Health Metrics and Evaluation indicate that global HBV vaccination levels have dropped significantly in 2020. Further, these worrisome levels are comparable to that of 1990.
The United State of America’s “Vaccines for Children,” a federally financed program, has also reported declines in vaccine ordering and administration following the national emergency declaration on March 13, 2020. This decline was particularly noted in children older than 24 months.
As such, reduced vaccinations in children may have an effect on the global burden of chronic infection and the long-term progress of HBV incidence mitigation.
“Sustaining HBV vaccination is further complicated by pandemic-driven bottlenecks in the supply chain of vaccines, increases in home births hindering administration of birth dose vaccine, changes in healthcare seeking behaviour and potential effects on vaccine hesitancy,” they wrote.
They also acknowledged the increasing politicization of vaccination along with government distrust may have had (and continue to have) an effect on willingness to take the vaccine.
Effects of Transmission
The analysis also reports a likelihood that the pandemic has altered that dynamics of viral transmissions, though evidence is currently limited.
The associations between lockdown and increased use of alcohol and drug use, unprotected sex, reduced anti-viral treatment availability, and increased home birth, can certainly increase the risk of HBV infection.
Further, restrictions following from lockdowns have disrupted harm reduction services, such as needle exchange and opioid substitution therapy. As such, these disruptions further pose risks for people who inject drugs and who are susceptible to overdoses.
Additionally, the increased global preponderance of at-home births may affect the availability of antenatal care services and thus increase the risk of vertical transmission.
“Reduced access to interventions for prevention of mother to child transmission (PMTCT) (including antenatal diagnostics, anti-viral therapy, hepatitis B immunoglobulin and vaccine birth doses) endangers a generation of individuals, who are more likely to develop chronic infection following exposure early in life,” the team noted.
Diagnosis and Healthcare Access
Across the healthcare spectrum, the pandemic has had a marked effect on diagnosis and screening, and programs related to HBV infection is no exception.
The COVID-19 crisis has forced the diversion of funding, human resources, and infrastructure to the pandemic response.
Additionally, fear of exposure to COVID-19 has been a noted contributing factor to this decline in screening.
“In April, health centres in Burkina Faso, the Gambia and Tanzania recorded significant declines in new patients reviewed in outpatient clinics compared with the start of the year, falling by 71%, 83% and 95%, respectively, with the primary reason cited as patients’ fear of entering health services,” Pley and team wrote.
In addition to screening, various health centers have noted a reduction in access to treatment.
According to a survey conducted by the World Hepatitis Alliance, 52% of frontline health workers in low- and middle-income countries reported that patients on treatment for viral hepatitis have been unable to access medication.
The great challenges faced by these healthcare centers and countries further amplify the existing and public health inequalities. Even more, the most vulnerable members of society, who are likely to have various comorbidities, are at simultaneous risk for HBV and COVID-19.
As noted by the investigators, it becomes imperative to use these findings as a basis for directing policy and research so that the impact of the ongoing pandemic on HBV prevention, diagnosis, and treatment can be mitigated.
The study, “The global impact of the COVID-19 pandemic on the prevention, diagnosis and treatment of hepatitis B virus (HBV) infection,” was published online in BMJ Global Health.