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World J Hepatol. Mar 27, 2012; 4(3): 74-80
Published online Mar 27, 2012. doi: 10.4254/wjh.v4.i3.74
Hepatitis B: Epidemiology and prevention in developing countries
Elisabetta Franco, Barbara Bagnato, Maria Giulia Marino, Cristina Meleleo, Laura Serino, Laura Zaratti
Elisabetta Franco, Laura Zaratti, Department of Public Health, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy
Barbara Bagnato, Maria Giulia Marino, PhD Program for Methodologies in Preventive Medicine and Therapy, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy
Cristina Meleleo, Laura Serino, Specialization School for Hygiene and Preventive Medicine, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy
Author contributions: Franco E coordinated the work; Bagnato B, Marino MG, Meleleo C, Serino L and Zaratti L performed the literature search and evaluation; all authors collaborated in writing the paper.
Correspondence to: Elisabetta Franco, MD, Professor of Hygiene, Department of Public Health, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy.
Telephone: +39-06-72596122 Fax: +39-06-2025285
Received: February 28, 2011
Revised: March 14, 2012
Accepted: March 17, 2012
Published online: March 27, 2012

Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.

Keywords: Hepatitis B, Developing countries, Endemicity, Seroprevalence, Vaccine