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Correspondence to Dr Shiyang Pan and Dr Hua-Guo Xu, Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; [email protected], [email protected]

Significance of this study

What is already known on this subject?

  • In the Sub-Saharan Africa study, the prevalence of hepatitis D virus (HDV) was assessed among HBsAg-positive populations in the African regions.

  • More studies are needed to determine the HDV burden and the risk factors for HDV infection worldwide.

  • These data are substantial to impel the routine screening for HDV and encourage hepatitis B virus (HBV) vaccine programme.

What are the new findings?

  • The prevalence of HDV among two special groups (intravenous drug users and people who have high-risk sexual behaviour) was both higher than the mixed population.

  • The pooled prevalence of HDV among population with HBsAg-positive was twofold as what was estimated before.

  • The emergence of new HDV genotypes in Europe highlights future challenges.

How might it impact on clinical practice in the foreseeable future?

  • The trend of HDV infection is not as optimistic as we imagined, suggesting further implementation of international guidelines of HDV screening and HBV vaccination programme.

Introduction

It was estimated that about 248 million individuals were HBsAg positive in 2010 globally.1 As of 2016, an estimated 468 million people were living with hepatitis B and 119 million people were newly infected in this year.2 Scientific studies have shown that the hepatitis B virus (HBV) infection, which was discovered in 1963 by Blumberg, is the most common cause of hepatocellular carcinoma (HCC) worldwide.3 The percentage of patients with liver cirrhosis and liver cancer due to HBV have increased substantially between 2006 and 2016.2 Hepatitis D virus (HDV) was first discovered by Rizzetto and colleagues in the mid-1970s while investigating a group of patients with HBV with severe hepatitis.4 HDV is a satellite virus that can propagate only with the existence of HBV.4 It is estimated that about 5% of chronic HBV carriers are coinfected with HDV based on the data published between the 1980s and 1990s,5 which means that around 15–20 million people are HDV carriers worldwide.6

Studies have consistently shown that the chronic HBV and HDV coinfection is the most severe form of viral hepatitis,5

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