Advancing hepatitis B elimination: A systematic review of global immunization progress and future directions

The World Health Organization (WHO) has set a target of eliminating viral hepatitis B and C by 2030. Vaccination against hepatitis B (HepB) remains the most effective strategy for controlling and eliminating Hepatitis B Virus (HBV) infection. The development of HepB vaccines started with plasma-derived vaccines, which have since been largely replaced by safer and more effective recombinant vaccines, now considered the gold standard for preventing HBV infections. More recently, mRNA-based vaccines have emerged as a promising platform. This study aims to review and provide an up-to-date comparative analysis of the characteristics, efficacy, effectiveness, and the impact of variants of concern across 17 HepB vaccines. It also highlights the global progress of HepB vaccination, with 191 implementing HepB vaccination for the entire country, and an estimated HBV prevalence of 0.7 % among children under 5 years in 2022. This achievement is driven by the strong safety profiles, high immunogenicity, and robust efficacy of current vaccines, which have demonstrated minimal side effects. Nevertheless, challenges persist in certain populations that do not respond adequately to vaccination. Here, we report the updated guidelines and propose strategies to improve the effectiveness of HepB vaccination for these specific populations.