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World J Gastroenterol. Jul 21, 2014; 20(27): 8998-9016
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.8998
Hepatitis B virus: Where do we stand and what is the next step for eradication?
Haruki Komatsu
Haruki Komatsu, Department of Pediatrics, Toho University Sakura Medical Center, Chiba 285-8741, Japan
Author contributions: Komatsu H wrote this article.
Correspondence to: Haruki Komatsu, MD, PhD, Department of Pediatrics, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba 285-8741, Japan. haruki-komatsu@chive.ocn.ne.jp
Telephone: +81-43-4628811 Fax: +81-43-4630801
Received: September 20, 2013
Revised: December 9, 2013
Accepted: April 15, 2014
Published online: July 21, 2014
Processing time: 304 Days and 10.7 Hours
Abstract

Hepatitis B (HB) virus (HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups: (1) universal vaccination alone; (2) universal vaccination with screening of pregnant women plus HB immune globulin (HBIG) at birth; and (3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach high-risk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.

Keywords: Cancer; Global Alliance for Vaccine and Immunization; Hepatitis B immune globulin; Hepatitis B virus; Hepatocellular carcinoma; Selective vaccination; Universal vaccination; World Health Organization

Core tip: Hepatitis B (HB) vaccines, which are the first vaccines that have been proven to prevent cancer, have played a crucial role in preventing HB virus (HBV) infection worldwide since their development in the 1980s. In particular, the HB vaccines have been rapidly integrated into the national immunisation programs of low-income countries since the Global Alliance for Vaccine and Immunization was launched in 2000. However, we have still not eradicated HBV. More than 240 million people worldwide are carriers of HBV. The vaccine strategies, current status of HBV infection, and unresolved issues related to controlling HBV infection are discussed in this review.