Progress Toward Hepatitis B Control

World Health Organization European Region, 2016-2019

Nino Khetsuriani, MD, PhD; Liudmila Mosina, MD; Pierre Van Damme, MD, PhD; Antons Mozalevskis, MD; Siddhartha Datta, MD; Rania A. Tohme, MD


Morbidity and Mortality Weekly Report. 2021;70(30):1029-1035. 

In This Article

Abstract and Introduction


In 2019, an estimated 14 million persons in the World Health Organization (WHO) European Region* (EUR) were chronically infected with hepatitis B virus (HBV), and approximately 43,000 of these persons died from complications of chronic HBV infection.[1] In 2016, the WHO Regional Office for Europe set hepatitis B control program targets for 2020, including 1) ≥90% coverage with 3 doses of hepatitis B vaccine (HepB3), 2) ≥90% coverage with interventions to prevent mother-to-child transmission (MTCT) of HBV, and 3) ≤0.5% prevalence of HBV surface antigen (HBsAg)§ in age groups eligible for vaccination with hepatitis B vaccine (HepB).[2–4] This report describes the progress made toward hepatitis B control in EUR during 2016–2019. By December 2019, 50 (94%) of 53 countries in EUR provided routine vaccination with HepB to all infants or children aged 1–12 years (universal HepB), including 23 (43%) countries that offered hepatitis B birth dose (HepB-BD) to all newborns. In addition, 35 (73%) of the 48 countries with universal infant HepB vaccination reached ≥90% HepB3 coverage annually during 2017–2019, and 19 (83%) of the 23 countries with universal birth dose administration achieved ≥90% timely HepB-BD coverage annually during that period. Antenatal hepatitis B screening coverage was ≥90% in 17 (57%) of 30 countries that selectively provided HepB-BD to infants born to mothers with positive HBsAg test results. In January 2020, Italy and the Netherlands became the first counties in EUR to be validated to have achieved the regional hepatitis B control targets. Countries can accelerate progress toward hepatitis B control by improving coverage with HepB and interventions to prevent MTCT and documenting achievement of the HBsAg seroprevalence target through representative serosurveys or, in low-endemicity countries, antenatal screening.

*EUR is one of six WHO regions and consists of the following 53 member states (total population, approximately 932 million): Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Moldova, Monaco, Montenegro, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Russia, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine, United Kingdom, and Uzbekistan.
In EUR, interventions to prevent MTCT of HBV include either 1) administering a timely birth dose of HepB vaccine to all newborns (universal birth dose policy) or 2) conducting routine antenatal screening of pregnant women for hepatitis B and vaccinating infants born to HBV-infected mothers with HepB birth dose within 24 hours of birth (selective birth dose policy), either of which is followed by ≥2 additional vaccine doses according to the national immunization schedule. In addition, some countries provide antiviral treatment to pregnant women with positive HBsAg test results and administer hepatitis B immune globulin at birth to infants of infected mothers.
§Before introduction of vaccination, the HBV endemicity in EUR, defined by HBsAg antigen seroprevalence, ranged widely from low (<2.0%) in 25 countries, to intermediate (2.0%–7.9%) in 25 countries, to high (≥8.0%) in three countries.
A timely HepB birth dose is defined as a dose administered within 24 hours of birth.