![]() Published HBV sequence data from Bangladesh documents a mixture of genotypes, with genotypes C and D each accounting for ∼40% of the total burden, and genotype A for the remainder, also noting a high proportion of recombinants and mixed genotype infections 3, 5, 13. Estimates suggest that CHB prevalence has declined from 8% to <6% since the vaccine initiative was introduced in Bangladesh in 2003 10, 11, but nevertheless, the perinatal incidence of new infections remains among the highest in South Asia 12. ![]() Interventions include programmes for screening donor blood by testing for hepatitis B surface antigen (HBsAg) 5, and delivery of universal infant HBV vaccination starting at age six weeks, through the World Health Organization (WHO) Expanded Programme for Immunization (EPI) 8, 9. In 2019, the Government of Bangladesh formulated a ‘National strategic plan for combating viral hepatitis in Bangladesh 2020-2030’ 7. In combination with the large population, this prevalence rate puts Bangladesh among the top ten high burden countries for viral hepatitis 6.īangladesh is progressively developing national strategies to tackle HBV 4. ![]() Bangladesh has an intermediate CHB prevalence, estimated at 2-6% 3, 4, although epidemiology may vary between geographic regions and according to sociodemographic factors 5. With an estimated 800,000 annual deaths resulting from CHB, ambitious elimination targets aiming to reduce viral hepatitis incidence by 90% have been established as a part of the UN Sustainable Development Goals for 2030 2. Global estimates indicate that approximately a third of the world’s population has been exposed to hepatitis B virus (HBV) during their lifetime, with chronic HBV infection (CHB) in over 260 million individuals worldwide 1. In order to work towards international Sustainable Development Goal targets for HBV elimination, increased investment is required for diagnosis, treatment and prevention in Bangladesh. The high prevalence of HBV in this setting highlights the benefits of offering screening in hospital patients and the importance of HBV DNA testing of transfusion products to reduce the risk of transmission. We identified mutations associated with nucleos(t)ide analogue resistance, although the clinical significance in this cohort is not known. Polymorphisms in the surface gene of the OBI case may account for the negative HBsAg status. Applying a target-enrichment sequencing pipeline to samples with HBV DNA >3.0log 10 IU/ml, we obtained deep whole genome sequences for four cases, identifying genotypes A, C and D. HBV exposure (anti-HBc) was documented in 72/201 (36%), and active HBV infection in 16/201 (8%), among whom 3 were defined as OBI (defined as detectable HBV DNA but negative HBsAg). We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of hepatitis B virus (HBV) infection and to identify cases of occult hepatitis B infection (OBI). Bangladesh is one of the world’s top ten burdened countries for viral hepatitis.
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