Epidemiology

The World Health Organization estimates that globally there were 254 million people living with chronic hepatitis B virus (HBV) infection in 2022, with 1.2 million new infections each year.[9] Globally, there were an estimated 1.1 million HBV-related deaths in 2022, mostly from cirrhosis and hepatocellular carcinoma.[9] It has been estimated that HBV infection could account for 42% of the global burden of cirrhosis.[10]

The highest burden of HBV infection is in the Western Pacific and African regions.[9] In endemic regions, ≥8% people have chronic HBV infection.[11] In areas of low endemicity (e.g., western Europe, North America, Australia), ≤2% people have chronic HBV infection. In addition, the lifetime risk of HBV infection varies widely around the world, from 80% in highly endemic regions to <20% in low-prevalence regions. The prevalence of HBV in the general population is <1% in most countries.[12]​​

The US and UK have historically been regions of low prevalence.

  • In the US, it has been estimated that 14,400 new acute HBV infections occurred in 2023, with 2214 acute cases actually reported. The rate of acute hepatitis B was 0.7 reported cases per 100,000 population, and has remained relatively stable since 2020. Approximately 48% of acute cases occurred among persons aged 40-59 years, and the rate was highest among non-Hispanic black people (1.9 times as high as the rate among non-Hispanic white people). A total of 17,650 new cases of chronic infection were reported in the US during 2023. The rate of chronic hepatitis B was 6.1 reported cases per 100,000 population. Approximately 46% of cases occurred in people aged 30-49 years, and the rate among non-Hispanic Asian/Pacific Islander people was 9.9 times higher than the rate among non-Hispanic white people. There were 1769 hepatitis B-related deaths reported in 2023.[13]​ It has been estimated that the prevalence of chronic HBV infection in the US may be as high as 2.4 million cases. The weighted average prevalence of chronic HBV infection for all foreign-born people in the US was 3.07% in 2018.[14]

  • In the UK, an average of 342 cases were reported annually in England between 2015 and 2022.​ The number of people living with chronic infection in England in 2022 was estimated to be approximately 268,767 (0.58% prevalence).[15]

In Europe, there were an estimated 2.1 million incident cases of acute HBV infection in 2019 across all age groups, with 8.2 million cases of HBV-related cirrhosis and approximately 25,000 deaths due to HBV-related cirrhosis.[16]

Globally, an estimated 6.4 million children aged ≤5 years are living with chronic HBV infection.[17] There are almost 2 million new infections in children aged <5 years globally each year, with most cases occurring as a result of mother-to-child transmission.[18] In the US, a total of 7 cases of perinatal HBV infection were reported during 2023.[13]​ In the UK, mother-to-child transmission has been eliminated in England.[19]

The prevalence of occult HBV infection (the presence of replication-competent HBV DNA in liver tissue or blood in patients who have tested negative for hepatitis B surface antigen [HBsAg]) was 0.8% in the general population, globally, with a higher prevalence in HIV patients (16%), patients with other liver diseases (14%), and haemodialysis patients (5%). However, the prevalence varies significantly across different populations and geographical locations, and is much lower in Western countries.[20]​ The prevalence of occult HBV infection in high-risk groups is substantial: 5.5% in low-endemicity countries; 5.2% in intermediate-endemicity countries; and 12% in high-endemicity countries.[21]

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