Seroprevalence of hepatitis B virus: Findings from a population-based household survey in KwaZulu-Natal, South Africa

•Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality.•Surveillance for HBV virus surface antigen (HBsAg) is an important measure of the burden of infection.•The presence of HBV nucleocapsid antigen (HBeAg) is an important measure of sustained transmission.•Scale-up of immunization and treatment is a missed opportunity to reduce the spread of HBV. Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality; however, little is known about the prevalence and distribution of HBV in some populations and regions. A total of 9791 participants, 15–49 years old, were enrolled in a household survey in KwaZulu-Natal, South Africa. Peripheral blood samples were tested for markers of HBV (hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe)) and analysed, accounting for multilevel sampling and weighted to represent the population. Overall HBsAg prevalence was 4.0% (95% confidence interval (CI) 3.4–4.5%): 4.8% (95% CI 3.8–5.8%) in men and 3.2% (95% CI 2.5–3.9%) in women (p=0.01). Among HBsAg-positive participants, 35.2% (95% CI 29.2–41.2%) were HBeAg-positive and 66.3% (95% CI 60.1–72.4%) were anti-HBe-positive. HBsAg prevalence was 6.4% (95% CI 5.3–7.5%) among HIV-positive participants compared to 2.6% (95% CI 1.9–3.2%) among HIV-negative participants (p