Transmission dynamics and the control of hepatitis B in China: a population dynamics view

Though the prevalence of hepatitis B began to decline for the first time in 2010, it remains unclear whether this downward trend is permanent and the disease will be eradicated in mainland China under the current measures. Because a large number of hepatitis B virus (HBV) carriers and unknown HBV infections is characteristic of HBV infections in China, a mathematical model was designed and fitted to the reported hepatitis B data. The estimated basic reproduction number is 1.2861 (95\% confidence interval (CI) 1.2386-1.3302), which remains greater than one. Thus, the decline in 2010 may be part of the temporary benefits of public policy measures and should not be interpreted as indicative of successful intervention, although interventions do provide some benefits. To assess the effects of various interventions, the global uncertainty and sensitivity analyses revealed that the contribution of carriers is always greater than that of acute infections, and the prevalence of hepatitis B in China may be primarily a result of transmission by unknown patients. Therefore, strategies for controlling the HBV endemic, which target known patients, are unlikely to be highly effective. Additionally, three feasible strategies are proposed, although the benefits of these strategies may change radically over time.