TABLE 3.
WHO HBV elimination targets and progress of United States and Canada
| Characteristic | WHO elimination targets | United States | Canada |
|---|---|---|---|
| WHO impact indicators | |||
| Prevalence of HBsAg in children ≤5 y of age | ≤0.1% HBsAg in ≤5-year-olds (≤100 cases/100,000 live births) |
No National Surveillance Data 0.03% (modeled)24 |
No National Surveillance Data <0.1%–0.34% (modeled)25 |
| Maternal-child transmission rate | ≤2% | 0.4%26 | No National Surveillance Data 1%–2%27 |
| Childhood 3-dose vaccine coverage | 90% | 92.1% coverage by 24 mo28 | 82.6% (79.7–85.1) of 2 y olds among 8 jurisdictions |
| Combined mortality attributable to HBV and HCV infection: Annual mortality rate from HCC, cirrhosis, and chronic liver diseases attributable to HBV and HCV infection | ≤6 HCV-related and HBV-related deaths/100,000 population per year | HBV-related deaths 0.45/100,00018 HCV-related deaths 3.18/100,000 age-adjusted death rate for HCV (2017–2021)18 |
HBV-related deaths 1.3 deaths /100,00025 HCV-related deaths 7.2/100,000 per year25 |
| WHO Program Indicators: Testing and Treatment of Infections | |||
| Proportion of people living with chronic hepatitis B who have been diagnosed | Elimination target: ≥90% Path to Elimination: Gold ≥80% Silver ≥70% Bronze ≥60% |
No National Surveillance Data 32%–33%29,30 |
No National Surveillance Data 71% (modeled)24 |
| Proportion of people diagnosed with chronic hepatitis B, who have been initiated on treatment | Elimination target: ≥80% of eligible Path to Elimination: Gold ≥70% Silver ≥60% Bronze ≥50% |
No National Surveillance Data 18% treated of people diagnosed with HBV (from claims data*)31 60.4% treated of those eligible by AASLD guidelines (from claims data)32 |
No National Surveillance Data 23% treated of people with HBV (modeled)24 |
| HBV prevention interventions (injection safety, blood screening, and harm reduction) | |||
| Proportion (%) of safe injections administered in health care setting | 100% | No National Surveillance Data Legislated since 2000 through “Needlestick Safety and Prevention Act” (NSPA) |
No National Surveillance Data Regulations exist for national standards |
| Proportion of devices with RUP or with SIP features procured at national (or health facility level if procurement is decentralized) | ≥90% | No National Surveillance Data NSPA requires safety-engineered devices regulated by Occupational Safety and Health Administration (OSHA) |
No National Surveillance Data Regulated requirements for safety devices exist among Provincial/Territorial but not nationally |
| Proportion (%) of blood units screened for bloodborne disease | 100% | 100% Blood safety regulated by FDA |
100% |
| No. syringes and needles distributed per PWID per year | Elimination: ≥300 Path to elimination: Gold: 150% or 100% coverage increase in the past 2 y Silver: NSPA present in the country Bronze: NSPA present in the country |
No National Surveillance Data 30 needle-syringes per PWID/y (modeled)30 |
Average 291 needle-syringes per PWID/year Range of 261–328 for 11 P/T having data (2016)33 |
| Coverage (%) of opioid substitution therapy (OST) among PWID | Elimination: ≥40% Path to Elimination: Gold:>20% OAT coverage or doubling OAT coverage in past 2 y Silver: OAT present in the country |
No National Surveillance Data State dependent |
~94% in Federal Correctional Facilities (patients with opioid use disorder; March 2023) National average of 66% (2016)33 |
Abbreviations: AASLD, American Association for the Study of Liver Diseases; FDA, Food and Drug Administration; NSPA, Needlestick Safety and Prevention Act; OAT, Opioid Agonist Therapy; OSHA, Occupational Safety and Health Administration; OST, opioid substitution therapy; PWID, Persons Who Inject Drugs; RUP, Reuse Prevention; SIP, Sharps Injury Protection; WHO, World Health Organization.