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

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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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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