To analyze the cost-effectiveness of various screening strategies for hepatitis B virus (HBV) infection in the Chinese population and to provide evidence for developing the most cost-effective strategy for HBV prevention and control in China.

Data on HBV infection-related costs, transition probabilities, and health utility values were obtained using literature analysis, polynomial regression model simulation, and reports or monographs from authoritative health institutions. We constructed a multi-stage decision tree model for 11 different target populations across various age groups ranging from 0 to 70 years in China under five serological testing strategies: hepatitis B surface antigen (HBsAg) rapid test (one-item screening), HBsAg/hepatitis B surface antibody (HBsAb) test (two-item screening), HBsAg/HBsAb/hepatitis B core antibody (HBcAb) test (three-item screening), HBsAg/HBsAb/hepatitis B e antigen (HBeAg)/hepatitis B e antibody (HBeAb)/HBcAb test (five-item screening), and no screening, with 10 μg doses of hepatitis B vaccine administered at 0, 1, and 6 months. A Markov model was used to simulate the health outcomes of susceptible individuals after HBV infection. We calculated the costs and effects of different screening strategies, compared the incremental cost-effectiveness ratios (ICERs) of different screening programs, and used univariate and probabilistic sensitivity analyses to assess the robustness of the results, using the 0–20 years age group as an example.

Baseline analysis showed that the three-item HBV screening strategy was the most cost-effective in the 0–20 years age group, with an investment of 3 188.19 yuan (RMB) yielding 26.74 quality-adjusted life years (QALYs). Compared with the three-item screening strategy, the five-item screening, two-item screening, one-item screening, and no screening strategies required additional investments of 27 178.37 yuan, 25 723.66 yuan, 25 723.07 yuan, and 25 696.48 yuan, respectively, per QALY lost, making them absolutely inferior strategies. In age groups other than 0–20 years, the five-item HBV screening strategy was the most cost-effective. The cost-effectiveness ranking, from highest to lowest, was as follows: 30–70 years, 0–30 years, 30–60 years, 20–70 years, 30–50 years, 20–60 years, 30–40 years, 20–50 years, 20–40 years, and 20–30 years. Compared with the three-item screening strategy in the 0–20 years age group, the five-item screening strategy in other age groups required additional investments of 352.20 yuan, 472.60 yuan, 492.98 yuan, 550.42 yuan, 757.71 yuan, 835.50 yuan, 1 018.78 yuan, 1 173.34 yuan, 1 910.08 yuan, and 2 612.61 yuan, respectively, per QALY lost, also making them absolutely inferior strategies. Using the 0–20 years age group as an example, univariate sensitivity analysis revealed that the vaccination rate had the greatest impact on net monetary benefit (NMB). Probabilistic sensitivity analysis demonstrated that the dominant strategy in this study had a greater cost-effectiveness advantage compared to other strategies. The sensitivity analysis results were consistent with those of the baseline analysis.

The three-item HBV screening strategy (including HBsAg, anti-HBc, and anti-HBs) was found to be the most cost-effective approach for preventing and controlling HBV infection in the Chinese population aged 0–20 years, compared to other screening strategies.

Analysis of the association between hepatitis B surface antigen (HBsAg) clearance and amino acid mutations in the pre-S/S region of the hepatitis B virus (HBV) in a cohort from Wuwei city, Gansu province.

A cohort of chronic hepatitis B (CHB) infected individuals was established at the Wuwei City Tumor Hospital in Gansu province during August 2018 and December 2022. Follow-up continued until December 31, 2022, with individuals who cleared HBsAg designated as the case group and those with persistent HBsAg positivity as the control group. Serum samples collected at baseline were subjected to next-generation sequencing (NGS) of the HBV pre-S/S region. Amino acid mutation rates and complexity were calculated. A sparse logistic regression (SLR) model was constructed to analyze the association between HBsAg clearance and amino acid mutations in the HBV pre-S/S region.

A total of 171 patients with complete genotype C sequences were included, with 23 in the HBsAg clearance group and 148 in the persistent positive group. The average mutation frequency (Z = 2.881) and complexity (Z = 3.255) in the S region were significantly higher in the HBsAg persistent positive group than in the clearance group (P < 0.05). Mutations at 121 amino acid sites showed statistically significant differences between the two groups (P < 0.05), with 20 sites identified as effective mutation sites. Except for site H132, all other sites showed higher mutation rates in the HBsAg persistent positive group than in the clearance group (P < 0.05). An SLR model identified six characteristic indicators significantly associated with HBsAg clearance: HBV DNA, Sn_271, Sn_399, Sn_194, P_121, and Sn_397, with HBV DNA having the highest contribution.

Changes in amino acid sites in the HBV pre-S/S region may influence HBsAg clearance. The application of the SLR model provides new insights for precision treatment of CHB.

Analysis of hepatitis B (HepB) vaccination coverage and its influencing factors among adults in eight Chinese cities.

Data were derived from a special survey on key infectious diseases among registered residents conducted in eight cities in eastern (Suzhou city, Qingdao city, Guangzhou city), central (Zhengzhou city, Changsha city), and western (Jiulongpo district of Chongqing city, Xishuangbanna prefecture, Ürümqi city) China as part of the 2017 National Migrant Population Health and Family Planning Dynamic Monitoring Project. A total of 9 671 individuals aged 18–45 years were included in the study. Chi-square tests and binary logistic regression models were used to analyze HepB vaccination coverage and its influencing factors.

The overall HepB vaccination coverage among the participants was 45.23%. Lower education levels were associated with a higher risk of not being vaccinated against HepB (P < 0.05). Lower HepB vaccination coverage was observed among adults residing in central and eastern regions, those with agricultural household registration, those who spent > 15 minutes traveling to healthcare facilities, those who had not heard of the National Essential Public Health Services program, those who had not received public health education, those who had not received face-to-face individualized health counseling, and those who had not received health education on sexually transmitted infections and AIDS (all P < 0.05). Among residents born before, during, and after the inclusion of HepB vaccination in the immunization program, lower education levels and residence in central and eastern regions were consistently associated with lower HepB vaccination coverage (all P < 0.05). Before the HepB vaccination program was promoted, not having heard of the National Essential Public Health Services program and lack of public health education and individual face-to-face counseling were associated with a higher risk of not being vaccinated against HepB. During the promotion period, being married, spending > 15 minutes traveling to healthcare facilities, and lack of public health education and education on sexually transmitted infections and AIDS were associated with a higher risk of not being vaccinated against HepB. After the inclusion of HepB vaccination in the immunization program, spending > 15 minutes traveling to healthcare facilities and not having received individual face-to-face counseling were associated with a higher risk of not being vaccinated against HepB.

HepB vaccination coverage among Chinese adults is primarily influenced by education level, region, time spent traveling to healthcare facilities, and health education.

To understand the prevalence of hepatitis B virus (HBV) infection and the effectiveness of HBV vaccination among community residents in Shanghai city, and to provide scientific evidence for optimizing current HBV prevention and control strategies.

Based on two-stage probability proportional to size (PPS) sampling, serological surveys of HBV were conducted among community residents aged 1–69 years in Shanghai city in 2018 and 2020. Basic information such as gender, age, household registration, and vaccination history were collected through questionnaires. Venous blood samples were collected for HBsAg, anti-HBs, and anti-HBc testing. For those aged 15–69 years who tested positive for HBsAg in the 2020 survey, further clinical examinations were conducted to assess whether they were HBV carriers, chronic hepatitis B patients, or cirrhosis patients. Based on population size and age structure, complex sampling weights were applied to adjust the survey data. Rao-Scott χ² tests were used for intergroup comparisons.

A total of 5 523 community residents in Shanghai city were included in this study. The positive rates of HBsAg, anti-HBs, and anti-HBc were 3.95%, 48.06%, and 32.69%, respectively. The positive rates of HBsAg and anti-HBc in the 5–29 age group were significantly lower than those in the 30–69 age group (Rao-Scott χ² = 20.20 and 179.24, respectively, both P < 0.0001), and significantly higher than those in the 1–4 age group (Rao-Scott χ² = 17.99 and 18.58, respectively, both P < 0.0001). The positive rate of anti-HBs in the 5–29 age group was significantly lower than that in the 1–4 age group (Rao-Scott χ² = 60.86, P < 0.0001). The positive rates of HBsAg and anti-HBc in the central urban area were significantly higher than those in the suburbs (Rao-Scott χ² = 38.26 and 11.12, respectively, both P < 0.001). The positive rate of anti-HBs in the registered population was significantly lower than that in the non-registered population (Rao-Scott χ² = 135.75, P < 0.0001). The infection risk among community residents has decreased significantly compared with previous years, and the infected population is mainly concentrated in those aged ≥ 40 years. Among community residents, the previous HBV vaccination rate was 32.95%. The positive rates of HBsAg and anti-HBc in vaccinated individuals were significantly lower than those in unvaccinated individuals (Rao-Scott χ² = 9.75 and 22.22, respectively, P < 0.01 and P < 0.0001, respectively), while the positive rate of anti-HBs was significantly higher in vaccinated individuals than in unvaccinated individuals (Rao-Scott χ² = 565.76, P < 0.0001). This survey also identified 16 suspected cases of early acute HBV infection, with an infection rate of 0.38%. Among the 27 HBsAg-positive individuals who underwent further clinical examination in 2020, HBV carriers accounted for 70.37%, chronic hepatitis B patients accounted for 14.81%, and cirrhosis patients accounted for 3.70%.

The HBsAg positive rate among community residents in Shanghai city has decreased from 6.78% in 1992 to 3.95% in 2018–2020. The HBsAg positive rate in children under 5 years old has approached the WHO target. Shanghai city is transitioning from an intermediate HBV endemic area to a low endemic area. It is recommended that, on the basis of continuing to strengthen HBV vaccination for newborns, vaccination for high-risk groups and antiviral treatment for HBV-infected individuals should be carried out in conjunction with surveillance efforts to contribute to the elimination of HBV.

To understand the incidence trend of hepatitis B virus (HBV) infection among children under 10 years of age in Shenzhen city, Guangdong province, from 2005 to 2023, and the influence of age, period, and birth cohort effects on this trend, to provide a reference for the development of local HBV prevention and control strategies.

Data on the incidence of HBV in children under 10 years of age in Shenzhen city from 2005 to 2023 were collected from the infectious disease surveillance module of the Chinese Center for Disease Control and Prevention Information System. Joinpoint regression was used to analyze the trends in HBV incidence and calculate the annual percentage change (APC) and average annual percentage change (AAPC). An age-period-cohort (APC) model was applied to estimate and simulate the age, period, and cohort effects on the risk of HBV infection in children under 10 years of age in Shenzhen city.

The incidence of HBV in children under 10 years of age in Shenzhen city decreased from 10.38/100 000 in 2005 to 1.26/100 000 in 2023 (AAPC = –12.20%, P < 0.001). The incidence of HBV showed a monotonic decreasing trend from 2005 to 2011 (APC = –11.30%, P = 0.012) and from 2018 to 2023 (APC = –31.47%, P < 0.001), while fluctuating irregularly from 2011 to 2018 (APC = 3.77%, P = 0.371). The APC model analysis showed that, in terms of age effects, the incidence of HBV was highest in the 0-year-old age group at 27.82/100 000 (95%CI: 20.13/100 000–38.46/100 000), decreased significantly from 0 to 2 years of age, fluctuated slightly from 2 to 6 years of age, and then gradually decreased with increasing age after 6 years of age, reaching the lowest level in the 9-year-old age group at 3.15/100 000 (95%CI: 2.13/100 000–4.65/100 000). In terms of period effects, the period effect of HBV incidence showed a downward trend over time, with the highest in 2006 (RR = 3.57, 95%CI: 2.33–5.47) and the lowest in 2023( RR = 0.32, 95%CI: 0.17–0.60). In terms of cohort effects, the later the birth cohort, the lower the risk of HBV infection in children. The cohort effect showed a fluctuating downward trend, with the highest in the 1996 birth cohort (RR = 1.39, 95%CI: 0.61–3.19) and the lowest in the 2020 birth cohort (RR = 0.08, 95%CI: 0.03–0.19). The local drifts of HBV incidence in all age groups of children under 10 years of age in Shenzhen city were less than 0, ranging from –13.04% (95%CI: –16.42% to –9.53%) in the 0-year-old age group to –4.92% (95%CI: –7.32% to –2.47%) in the 9-year-old age group, and the incidence of HBV in all age groups showed a downward trend over time.

The incidence of HBV in children under 10 years of age in Shenzhen city showed an overall downward trend from 2005 to 2023, indicating that the HBV prevention and control efforts in this area have been effective.

To analyze the epidemiological characteristics, spatial-temporal clustering, and change trend of hepatitis B among children aged under 15 years in Guangxi Zhuang Autonomous Region from 2009 to 2023.

The research data were collected from the China Information System of Disease Control and Prevention. The descriptive analysis, spatial autocorrelation analysis, and spatio-temporal scanning analysis were performed to explore the spatio-temporal distribution characteristics and clustering pattern of hepatitis B in children aged under 15 years in Guangxi Zhuang Autonomous Region.

From 2009 to 2023, the reported incidence of hepatitis B in children aged under 15 years in Guangxi Zhuang Autonomous Region showed a downward trend. The sex ratio of male to female incidence was 1.77∶1. The average annual incidence was the highest (6.35/100 000) in the age group of 10 to <15 years. Spatial autocorrelation analysis showed that there was significant spatial clustering in the incidence of hepatitis B among children in Guangxi Zhuang Autonomous Region. High-high clustering was mainly concentrated in western Guangxi Zhuang Autonomous Region and some central regions, while low-low clustering was concentrated in northeastern Guangxi Zhuang Autonomous Region. Spatiotemporal scanning analysis detected 2 high-incidence clusters and 1 low-incidence cluster.

The prevention and control of hepatitis B in children in Guangxi Zhuang Autonomous Region has achieved remarkable results, while there is still a phenomenon of spatial-temporal clustering. In high-incidence areas, it is necessary to strengthen strategies such as vaccination, mother-to-child blocking, and health education. In low-incidence areas, existing prevention and control measures should be kept to consolidate the reduction in the incidence of hepatitis B in children.

To evaluate the effectiveness of hepatitis B vaccination in Fenghua district, Ningbo city from 1992 to 2020.

The epidemiological survey data on hepatitis B serology in Fenghua district in 1992 and 2020 were collected for comparison of the positive rates of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs). Furthermore, data on the incidence of hepatitis B from 1992 to 2020 were collected for comparison of the average annual incidence of hepatitis B during the planned immunization management stage (1992–2001), the immunization planning management stage (2002–2011), and the implementation stage of the hepatitis B mother-to-child transmission prevention strategy (2012–2020). The decision tree-Markov model was adopted to evaluate the effectiveness of hepatitis B vaccination in newborns from 1992 to 2020.

The positive rate of HBsAg across the entire population declined from 13.79% in 1992 to 5.42% in 2020 (χ² = 31.73, P < 0.01), with all age groups within the cohort of 0–24 years old experiencing a reduction to 0%. The positive rate of anti-HBs in the age group of 0–4 years old increased from 34.48% in 1992 to 90.16% in 2020 (χ² = 30.38, P < 0.01). The incidence of hepatitis B significantly decreased among individuals aged 0–29 years old. Particularly, the age groups of 0–4, 5–9, and 10–14 years old during 2012–2020 showed declines of 86.08%, 94.63%, and 94.55% respectively, compared with those in 1992–2001. According to the decision tree-Markov model, compared with those who did not receive hepatitis B vaccination, the vaccination among 114 670 individuals in Fenghua district from 1992 to 2020 prevented 6 894 cases of acute hepatitis B, 30 832 cases of hepatitis B carriers, 4 705 cases of chronic hepatitis B, 4 043 cases of liver cirrhosis, 3 265 cases of liver cancer, and 4 411 hepatitis B-related deaths.

The hepatitis B vaccination program in Fenghua district has yielded remarkable results, significantly decreasing both the positive rate of HBsAg and the incidence of hepatitis B among young age groups. It is imperative to continue enhancing the hepatitis B vaccination efforts for newborns.