ABSTRACT
Background and aims: The country of Georgia launched its national Hepatitis C Virus (HCV) Elimination Program in 2015, and a serosurvey the same year showed prevalence of HCV antibody (anti-HCV) and HCV RNA among adults aged ≥18 years was 7.7%, and 5.4%, respectively. Since then, over 76, 000 people with chronic HCV have been treated, with a cure rate of 98.9%. To monitor progress, a second serosurvey was conducted in 2021 to estimate the prevalence of hepatitis C, hepatitis B, and anti-SARS-CoV-2. This analysis reports hepatitis C results of the serosurvey and progress towards elimination. Method: The serosurvey used a stratified, multi-stage cluster design with systematic sampling. Adults and children ≥5 years consenting (or assenting with parental consent) to the interviewand blood draw were eligible to participate. All blood samples were tested for anti- HCV and if positive, HCV RNA. Nationally representative weighted proportions and 95% confidence intervals (CI) were calculated and compared with 2015 age-adjusted estimates for adults. Results: A total of 7, 237 adults and 1, 473 children participated in the survey. For adults, the median age was 46 years (interquartile range: 32–60), and 53.3% (95% CI: 51.3–55.2)were female. The prevalence of anti-HCV was 6.8% (95% CI: 5.9–7.7), which was not significantly different from 2015 (7.7% [95% CI: 6.6–8.8];p = 0.20). The HCV RNA prevalencewas 1.8% (95% CI: 1.3–2.4), compared to 5.4% [95% CI: 4.5– 6.3] in 2015 (p < 0.001). This represents a 67% reduction in persons with chronic HCV infection, despite the program having treated 51% of the estimated 150, 000 infected. HCV RNA prevalence decreased among all age groups, most notably among those aged 40–59 years (9.3% in 2015 to 2.2% in 2021;p < 0.001). Substantial decreases were also observed among both males (9.0% to 3.1%;p < 0.001) and females (2.2% to 0.6%;p < 0.001). HCV RNA prevalence also decreased from 51.1% to 17.8% among persons who ever injected drugs, and 13.1% to 3.8% among those who received a blood transfusion (both p < 0.001). No children tested positive for anti-HCV or HCV RNA. Conclusion: These results demonstrate the substantial progress made since Georgia launched its HCV Elimination Program in 2015. The 67% reduction in chronic HCV infections during 2015–2021 also supports treatment as a means for prevention, as the reduction is larger than would be expected based on those treated alone. These findings can inform strategies to meet HCV elimination targets.
ABSTRACT
Background and aims: Georgia introduced routine infant hepatitis B (HepB) vaccination in 2001 with >90% coverage over the last decade. In 2015, a nationwide serosurvey demonstrated an anti-hepatitis B core antibody (anti-HBc) prevalence of 25.9% and hepatitis B surface antigen (HBsAg) prevalence of 2.9% among adults ≥18 years. No prevalence data were available for children. In 2021, we assessed hepatitis B virus (HBV) infection prevalence among children and updated estimates for adults in a combined COVID-19, hepatitis C and hepatitis B serosurvey of persons aged ≥5 years. Method: We used a stratified, multi-stage cluster design. We collected data on demographics, medical and exposure history;we tested blood samples for anti-HBc and, if positive, for HBsAg. Nationally representative weighted proportions and 95% confidence intervals (CI) for anti-HBc and HBsAg were calculated. Participants aged 5–20 years had been eligible for routine HepB vaccination as infants. Results: Among children aged 5–17 years, 0.7% were anti-HBc+ and 0.03%were HBsAg+ (Table). Among adults ≥18 years, 21.7%were anti- HBc+ and 2.7%were HBsAg+. Anti-HBc prevalence increased with age from 1.3% among 18–23-year-olds to 28.6% among ≥60 years. HBsAg prevalence was lowest (0.2%) among 18–23-year-olds and highest (8.6%) among 35–39-year-olds. Males had higher HBsAg prevalence than females (3.6% versus 2.0%;p = 0.003). Anti-HBc prevalence was highest in Samegrelo-Zemo Svaneti, Adjara, and Imereti regions. Higher education and income were associated with lower anti-HBc, and unemployment-with higher HBsAg prevalence. (Table Presented) Conclusion: The impact of HepB vaccination in Georgia is demonstrated by a low HBsAg prevalence among children that is below the 0.5% European regional hepatitis B control target and meets the ≤0 .1% seroprevalence target for elimination of mother-to-child transmission of HBV. Chronic HBV infection remains a problem among adults born before routine infant HepB vaccination. Focusing efforts on screening, treatment, and preventive interventions among adults, along with sustaining high immunization coverage among children, can help Georgia achieve elimination of hepatitis B as public health threat by 2030.