Hepatitis B and D burden in Uzbekistan: comprehensive analysis of seroprevalence and risk correlates from a countrywide study

Abstract

Abstract Background Uzbekistan faces a substantial burden of hepatitis B and D virus (HBV and HDV) infections despite implementing universal hepatitis B vaccination in 1998. Regional variation in disease distribution and contemporary transmission dynamics remain inadequately characterized. Our objective was to evaluate the geographically stratified prevalence of HBV and HDV, while also identifying the key risk factors fueling transmission within the adult population of Uzbekistan. Methods We conducted a nationwide cross-sectional study of 10,552 adults across seven regions of Uzbekistan from July 2022 to June 2024. Participants were selected using stratified random sampling from a parent cohort of 1,048,575 individuals. Serological testing included hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), anti-HDV antibodies, and viral RNA detection. Multivariate logistic regression identified independent risk factors for HBV and HDV infections. Results Overall HBsAg prevalence was 4.7% (95% CI : 4.3–5.1%), with substantial geographic heterogeneity ranging from 3.2% in Tashkent to 6.3% in Bukhara. Among HBsAg-positive individuals, 68.1% had detectable HBV DNA and 12.7% had HDV superinfection. HDV RNA prevalence among HBV DNA-positive individuals ranged from 2.5% to 23.7% across regions. Age-cohort analysis demonstrated vaccination program impact, with older unvaccinated adults bearing disproportionate disease burden. Female sex associated with 31% lower odds of chronic HBsAg carriage. Married status, healthcare-associated exposures, and body piercings correlated with increased anti-HBc positivity. Remarkably, sharing personal hygiene items showed striking HDV-specific association (a O R 2.34, 95% CI : 1.16–4.74; P = 0.02) but no association with HBV markers, suggesting distinct transmission pathways for HDV superinfection. Conclusions Persistent HBV burden with notable regional clustering and HDV superinfection necessitates targeted interventions. The identification of personal hygiene item sharing as a specific HDV transmission route provides an actionable household-level prevention target. Intensified screening and treatment of unvaccinated adults remain critical for hepatitis elimination efforts.