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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 11941-11953
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.11941
Hepatitis B virus burden in developing countries
Rosa Zampino, Adriana Boemio, Caterina Sagnelli, Loredana Alessio, Luigi Elio Adinolfi, Evangelista Sagnelli, Nicola Coppola
Rosa Zampino, Adriana Boemio, Luigi Elio Adinolfi, Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Second University of Naples, 80135 Naples, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, 80135 Naples, Italy
Loredana Alessio, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80135 Naples, Italy
Evangelista Sagnelli, Department of Mental Health and Public Medicine, Second University of Naples, Honorary Professor of Infectious Diseases, 80135 Naples, Italy
Author contributions: Zampino R conceived and drafted the article and approved the final version; Boemio A, Sagnelli C and Alessio L reviewed the literature, contributed to drafting the article and approved the final version; Adinolfi LE, Sagnelli E and Coppola N critically reviewed the manuscript and approved the final version.
Conflict-of-interest statement: None of the authors have any conflict of interest in connection with this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rosa Zampino, MD, PhD, Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Second University of Naples, Via Pansini 5, 80135 Naples, Italy. rosa.zampino@unina2.it
Telephone: +39-81-5666708 Fax: +39-81-5666707
Received: April 26, 2015
Peer-review started: April 27, 2015
First decision: July 13, 2015
Revised: July 23, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Abstract

Hepatitis B virus (HBV) infection has shown an intermediate or high endemicity level in low-income countries over the last five decades. In recent years, however, the incidence of acute hepatitis B and the prevalence of hepatitis B surface antigen chronic carriers have decreased in several countries because of the HBV universal vaccination programs started in the nineties. Some countries, however, are still unable to implement these programs, particularly in their hyperendemic rural areas. The diffusion of HBV infection is still wide in several low-income countries where the prevention, management and treatment of HBV infection are a heavy burden for the governments and healthcare authorities. Of note, the information on the HBV epidemiology is scanty in numerous eastern European and Latin-American countries. The studies on molecular epidemiology performed in some countries provide an important contribution for a more comprehensive knowledge of HBV epidemiology, and phylogenetic studies provide information on the impact of recent and older migratory flows.

Keywords: Hepatitis B virus, Molecular epidemiology, Prevention, Developing countries, Chronic hepatitis

Core tip: Hepatitis B virus (HBV) infection is a heavy burden in most developing countries because of its wide spread, particularly in rural areas, and the high cost of prevention, management, and treatment. Therefore, a greater effort should be made towards implementing universal vaccination programs as they have been demonstrated to be effective in reducing the incidence of acute hepatitis B and the prevalence of hepatitis B surface antigen chronic carriers. In several low-income countries, an improvement in the current knowledge of HBV epidemiology, molecular epidemiology, HBV replication and co-infection with other viruses such as hepatitis C virus and human immunodeficiency virus is strongly desired.