Hepatitis B is most common in sub-Saharan Africa and the Western Pacific region, which together account for the majority of the world’s 254 million chronic infections. The virus circulates at much lower rates in Western Europe, North America, and parts of South America, where widespread vaccination and screening have kept prevalence below 1% in most countries.
The Two Highest-Burden Regions
Sub-Saharan Africa and the Western Pacific (which includes China, the Philippines, Vietnam, and Pacific Island nations) stand out as the regions where hepatitis B has the deepest foothold. In the Western Pacific alone, the WHO estimated prevalence among the general population at roughly 6% in 2019, meaning about one in every 17 people carries the virus chronically. Parts of sub-Saharan Africa see similar or higher rates, with some countries exceeding 8% prevalence.
These two regions share a critical feature: the virus spreads primarily during the earliest years of life. In highly endemic areas, infection most often passes from mother to child during birth, or between young children through close household contact during the first five years. This pattern matters because the younger a person is at infection, the more likely the virus becomes chronic. A baby infected at birth has roughly a 90% chance of developing a lifelong infection, compared to less than 5% for a healthy adult.
Why Some Countries Have Higher Rates
Within those two broad regions, prevalence varies dramatically by country. Several factors explain why certain nations carry heavier burdens than others.
Vaccination timing is one of the biggest. The hepatitis B vaccine given within 24 hours of birth is the single most effective tool for stopping mother-to-child transmission. Globally, only 45% of newborns receive this birth dose. In the Western Pacific, coverage reaches 79%, which helps explain why rates there have been falling. In the WHO African Region, birth dose coverage sits at just 17%, leaving the vast majority of newborns in high-prevalence countries unprotected during their most vulnerable window.
Healthcare infrastructure also plays a role. Countries with limited access to sterile medical equipment, blood screening, and prenatal testing see more transmission through unsafe injections and unscreened blood transfusions. In wealthier nations, routine screening of pregnant women and blood donations has nearly eliminated these routes of spread.
Hepatitis B in Low-Prevalence Countries
In the United States, Western Europe, Australia, and Japan, chronic hepatitis B prevalence in the general population typically falls below 1%. But that national average can be misleading because certain communities within these countries carry rates that rival endemic regions.
Refugees and migrants who were born in high-prevalence countries often arrive with chronic infections acquired in childhood. A systematic review found an overall hepatitis B prevalence of 7.2% among refugees and migrants arriving in high-income, low-prevalence countries. The rates varied enormously depending on country of origin: 0.58% among Iraqi refugees in one study, but 12.5% among refugees from South Sudan. Another study of nearly 5,000 US-bound refugees from countries including Bhutan, Myanmar, Somalia, and Iraq found an overall prevalence of 12.1%.
This means that in cities with large immigrant communities from sub-Saharan Africa or Southeast Asia, local prevalence can be significantly higher than the national figure suggests. Many of these individuals were never screened or treated in their home countries, making community-based testing programs in resettlement areas especially important.
A Massive Diagnosis Gap
One of the most striking features of hepatitis B globally is how many people carry it without knowing. As of WHO’s 2016 estimates (the most recent detailed breakdown), only about 10.5% of people living with chronic hepatitis B had been diagnosed. Of those who were diagnosed, just 17% were receiving antiviral treatment. That means roughly 230 million people were living with an infection they didn’t know about, and the vast majority of those who did know weren’t being treated.
This gap is concentrated in the same high-burden regions. In many parts of sub-Saharan Africa, routine hepatitis B screening simply isn’t part of standard medical care. People often discover their infection only after developing serious liver damage, which can take decades. Chronic hepatitis B is the leading cause of liver cancer in much of Africa and Asia, and the virus kills an estimated 3,500 people every day worldwide from complications like cirrhosis and liver cancer.
How the Global Picture Is Shifting
Childhood vaccination has dramatically changed the trajectory of hepatitis B in several formerly high-prevalence countries. China is the clearest example: after introducing universal infant vaccination in the 1990s and expanding the birth dose program, the country cut new chronic infections among children by over 90%. Taiwan, South Korea, and Thailand have followed similar paths. The virus hasn’t disappeared from these populations, because millions of adults infected before vaccination programs began still carry it, but new infections among children have plummeted.
The WHO’s global elimination targets call for a 90% reduction in new chronic infections and a 65% reduction in deaths by 2030, compared to continuing current efforts unchanged. Meeting those targets depends on expanding birth dose vaccination in Africa, scaling up screening and treatment in all high-burden regions, and preventing transmission through safe injection practices and blood screening. Progress has been uneven. The Western Pacific is closer to these goals, while sub-Saharan Africa lags furthest behind, largely due to the low birth dose coverage and limited access to antiviral therapy.
For the 254 million people currently living with chronic hepatitis B, the challenge is no longer a lack of effective tools. Vaccines prevent nearly all new infections when given at birth, and antiviral medications can suppress the virus in those already infected. The gap is in reaching the people who need them most, particularly in the regions where the virus remains most deeply entrenched.