Hepatitis B Vaccination: A Success Story - Gastroenterology | March 26

Introduction

Hepatitis B virus (HBV) infection remains a major global health threat, with an estimated 254 million people living with chronic infection and more than 1.1 million deaths annually from cirrhosis and hepatocellular carcinoma (HCC). Because HBV infection acquired in infancy carries up to a 90% risk of chronic infection, prevention through vaccination—particularly the birth dose—has become the cornerstone of global elimination strategies.

Summary

This commentary highlights the profound public health impact of hepatitis B vaccination and underscores the need to sustain universal infant immunization. Since the introduction of HBV vaccines in the 1980s, global vaccination programs have prevented millions of infections and deaths. Universal infant vaccination, including a birth dose within 24 hours, has been especially transformative. Taiwan’s national program reduced chronic HBV prevalence from 10% in 1984 to 0.5% by 2019 and significantly lowered childhood hepatocellular carcinoma incidence. Globally, vaccination has reduced HBsAg prevalence among children under five years from approximately 5% to below 1%, preventing an estimated 22 million deaths.

Hepatitis B vaccines are among the safest and most effective vaccines ever developed, with over one billion doses administered worldwide and protective immunity lasting more than three decades. The combination of maternal screening, birth dose vaccination, hepatitis B immunoglobulin for exposed infants, and antiviral therapy during pregnancy can prevent up to 99% of mother-to-child transmission.

Despite these successes, challenges remain. Global birth-dose coverage is only about 46%, with particularly low uptake in Africa. In addition, policy debates in some countries about delaying infant vaccination risk reversing decades of progress. The authors emphasise that universal birth-dose vaccination is the most effective and cost-efficient strategy to eliminate HBV transmission and prevent future liver disease and cancer. Sustaining and expanding vaccination coverage is essential to achieving global hepatitis B elimination goals.