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Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control

Nature Medicine volume 7, pages 619–624 (2001)Cite this article

Abstract

Hepatitis-B virus infection is globally ubiquitous, but its distribution is very heterogeneous, with prevalence of serological markers in various nations ranging from less than 1% to more than 90%. We propose an explanation for this diversity using a mathematical model of hepatitis-B virus transmission dynamics that shows, for the first time, 'catastrophic' behavior using realistic epidemiological processes and parameters. Our major conclusion is that the prevalence of infection is largely determined by a feedback mechanism that relates the rate of transmission, average age at infection and age-related probability of developing carriage following infection. Using the model we identify possible, highly non-linear, consequences of chemotherapy and immunization interventions, for which the starting prevalence of carriers is the most influential, predictive quantity. Taken together, our results demand a re-evaluation of public health policy towards hepatitis-B.

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Figure 1: Equilibrium proportion seropositive as determined by the basic reproduction number (R0).
Figure 2: The relationships between probability of carriage development, age and rate of infection.
Figure 3: The effects of an instantaneous change on (log) carrier prevalence.
Figure 4: The effect of immunization with respect to (log) carrier prevalence.

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Authors and Affiliations

  1. Department of Biological Sciences, Ecology and Epidemiology Group, University of Warwick, Coventry, UK

    Graham F. Medley & D. James Nokes

  2. Xilinx Scotland, Edinburgh, UK

    Nathan A. Lindop

  3. Immunisation Division, CDSC, London, UK

    W. John Edmunds

  4. Wellcome Trust Research Labs, Kenya Units, Kilifi, Kenya

    D. James Nokes

Authors
  1. Graham F. Medley
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  2. Nathan A. Lindop
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  4. D. James Nokes
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Correspondence to Graham F. Medley.

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Medley, G., Lindop, N., Edmunds, W. et al. Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control. Nat Med 7, 619–624 (2001). https://doi.org/10.1038/87953

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