A tiny nation's big leap toward eliminating a silent killer.
For decades, chronic hepatitis B virus (HBV) infection has been a major global health threat, a leading cause of liver cirrhosis and cancer worldwide. In the country of Georgia, the burden was particularly heavy, with an estimated 2.9% of adults living with chronic HBV in 2015 .
This is the story of how Georgia, through two decades of dedicated vaccination, has transformed its public health landscape, nearly wiping out the virus in its younger generation and providing a blueprint for the world in the race to eliminate viral hepatitis.
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). Unlike its cousin hepatitis C, which is curable, hepatitis B often requires lifelong management. The virus spreads through contact with blood or other body fluids from an infected person 7 .
A key feature of HBV is its predilection for chronicity; about 90% of infants infected at birth will develop a chronic infection, compared to only about 5% of infected adults 7 . This makes preventing transmission to newborns absolutely critical.
The most reliable shield against this virus is vaccination. The first commercial hepatitis B vaccine was approved in 1981, with a safer, genetically engineered version introduced in 1986 that cannot cause infection 3 . When administered in a complete series, the modern vaccine is more than 90% effective at preventing infection 7 .
of infants infected at birth develop chronic HBV
of infected adults develop chronic HBV
vaccine effectiveness with complete series
Recognizing the severe burden of viral hepatitis, Georgia took decisive action. The country integrated the hepatitis B vaccine into its national immunization program in 2001 . A crucial enhancement came just two years later with the introduction of a monovalent birth dose (HepB-BD) for all newborns, a key weapon to prevent mother-to-child transmission .
| Period | Birth Dose | Subsequent Doses | Total Doses |
|---|---|---|---|
| 2001–2002 | No | 3 doses (2, 3, 8 months) | 3 |
| 2003–2009 | Yes | 3 doses (B, 2, 4 months) | 3 |
| 2010–Present | Yes | 3 doses of pentavalent/hexavalent vaccine (B, 2, 4 months) | 4 |
Hepatitis B vaccine integrated into national immunization program
Introduction of monovalent birth dose for all newborns
Transition to pentavalent/hexavalent vaccine schedule
HepB3 coverage consistently exceeds 90%
The results of this consistent effort were striking. Immunization coverage with three or more doses (HepB3) has been consistently above 90% since 2012 . This high coverage laid the foundation for a public health success story.
To scientifically measure the impact of its vaccination program, Georgia conducted a nationwide, cross-sectional household serosurvey in 2021. This was a massive undertaking designed to provide a accurate picture of HBV infection across the country.
The survey's methodology was rigorous, ensuring the findings would be reliable :
| Research Reagent / Tool | Function in the Study |
|---|---|
| Anti-HBc Test | A screening test to identify individuals who have ever been exposed to the hepatitis B virus. |
| HBsAg Test | A confirmatory test performed on Anti-HBc positive samples to determine if a person has a current, active chronic infection. |
The results, published in 2023, were nothing short of dramatic . They painted a clear picture of a generational divide driven directly by vaccination.
| Age Group | HBsAg Positive (%) | Anti-HBc Positive (%) | Key Context |
|---|---|---|---|
| Children (5-17 years) | 0.03% | 0.7% | Born after vaccine introduction; eligible for infant vaccination. |
| Young Adults (18-23 years) | 0.2% | 3.3% | Transition group, partially benefiting from vaccination. |
| Adults (35-39 years) | 8.6% | 35.8% | Born before the vaccine was available. |
| All Adults (≥18 years) | 2.7% | 21.7% | Reflects the ongoing burden in the pre-vaccine era population. |
The data speaks volumes. The 0.03% HBsAg prevalence among children is not just low; it is a monumental achievement. It is well below the 0.5% hepatitis B control target set by the WHO European Region and, impressively, meets the stringent ≤0.1% HBsAg seroprevalence target for the elimination of mother-to-child transmission of HBV 1 .
HBsAg prevalence in children (5-17 years)
WHO hepatitis B control target
Elimination of mother-to-child transmission target
Georgia's success demonstrates the profound, long-term power of vaccination as a public health tool. The near-elimination of hepatitis B in children means a future with drastically lower rates of HBV-induced liver cirrhosis and cancer.
However, the work is not complete. As the survey showed, chronic HBV infection remains a significant problem among adults born before the vaccine introduction, with an estimated 77,000 Georgians living with the virus in 2021 5 . The challenge now is to link this population to care and treatment to prevent further disease progression.
Georgia's journey offers a powerful model for other nations. It shows that with political will, a structured vaccination program, and high coverage rates, the elimination of hepatitis B is an achievable goal. The country is now building on this success by scaling up hepatitis B screening and treatment for adults, accelerating its progress toward the WHO's goal of global viral hepatitis elimination by 2030 1 .
The story of hepatitis B in Georgia is a testament to the fact that when science, policy, and public commitment align, we can win the battle against even the most persistent viral foes.