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Liver Update: Effect of COVID-19 pandemic on the prevention, diagnosis and treatment of HBV infection

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eMediNexus    23 July 2021

COVID-19 caused by the SARS-CoV-2 virus has caused multiple interventions with an objective of reducing the public health effect of this virus. On the contrary, several studies both from high-income and low-income countries have demonstrated severe consequences of such interventions on economic and public health inequalities, along with pre-existing programmes targeting endemic pathogens.

The present study offers an overview of the effect of the ongoing COVID-19 pandemic on hepatitis B virus (HBV) programmes worldwide, highlighting the possible effects for prevention, diagnosis and treatment. Ongoing disturbances to infrastructure, supply chains, services and strategies for HBV might play a disproportionate role in the short-term incidence of chronic hepatitis B. This in turn, offers a long-term source of onward transmission to future generations that could impede the progress towards the 2030 elimination goals.

Earlier data showed that routine immunisation programmes are highly susceptible to vary due to epidemics, political upheaval or economic crises. Initial data from the Institute for Health Metrics and Evaluation revealed that overall global vaccination coverage levels in 2020 have reduced to levels last seen in the 1990s, slowing 25 years of development in just 6 months. This drop in vaccination coverage causes strong repercussions on HBV incidence in infancy and early childhood, implicated in increased global burden of chronic HBV infection. It has been estimated that results of the COVID-19 pandemic on HBV vaccination and control may even outweigh the number of deaths caused by COVID-19 in the long term.

Evidence suggests although the transmission of HBV may have reduced due to physical contact and movement restrictions imposed in many countries, COVID-19 may have also led to a rise in risk behaviours for its transmission, including alcohol and drug use, unprotected sex, reduced anti-viral treatment availability and increased home births. Interruption of harm reduction services, including needle exchange and opioid substitution therapy effect the health of people who inject drugs and increases the risk of overdoses along with increase in the risk of transmission of blood-borne viral infections.

Besides, it was observed before COVID-19 pandemic, only approximately 1% of viral hepatitis cases were diagnosed in sub-Saharan continents. The pandemic increases the difficulty in identifying infections, the impact of disrupted vaccination campaigns, prevention of mother to child transmission (PMTCT) programmes (including antenatal diagnostics, antiviral therapy, hepatitis B immunoglobulin and vaccine birth doses) and antiviral treatment on the HBV epidemic will be more than reduced diagnostic capacity. However, missed diagnoses will also reduce the entry of infected patients into care and can have a long-term impact on transmission dynamics.

Moreover, COVID-19 also influences the access to treatment of HBV infections. Clinical guidelines suggests that HBV therapy should be initiated and continued irrespective of COVID-19 status of the patient. Nevertheless, access to healthcare has been restricted for HBV-positive individuals due to several interdependent factors, including redirected finances, redeployment of health workers, closure of facilities, supply chain disruptions, movement restrictions, fear of entering health facilities and the impracticality of telemedicine in many settings. 

Another important reason of increasing the risk of hepatitis infections in pandemic are increasing existing economic and public health inequalities. The pandemic is causing a worldwide recession and the contraction of national economies, that are pushing millions of people below the poverty line, particularly in countries without universally accessible health systems and expensive health facilities. Additionally, the most susceptible members of society are more probable to be affected by HBV, and they more likely to have comorbid non-communicable diseases, which can amplify the risk of a severe COVID-19 disease course. 

Source: Pley CM, McNaughton AL, Matthews PC, et al. The global impact of the COVID-19 pandemic on the prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. BMJ Global Health 2021;6:e004275. Available at: https://gh.bmj.com/content/6/1/e004275

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