Estimating the prevalence of hepatitis B by wastewater-based epidemiology in 19 cities in China

China has the world's largest burden of Hepatitis B virus (HBV) infection, with 86 million HBV carriers, including 32 million chronic Hepatitis B patients. To monitor the HBV prevalence in near real-time, a wastewater-based epidemiology (WBE) method by using lamivudine as a biomarker was conducted in 19 cities in the Southern part of China. LC-MS/MS was utilized to quantify lamivudine in sewage, and satisfactory method validation results were achieved. The average concentration of lamivudine in sewage was 156.4 ± 107.1 ng/L, and the daily consumption was 30.1 ± 19.8 mg/day/1000inh in average ranging from 0.4 to 105.5 mg/day/1000inh. The prevalence of chronic Hepatitis B was estimated to be 2.5% ± 1.7% based on the prevalence of lamivudine usage, which was 0.035% ± 0.023%. Besides, the estimated HBV prevalence in population aged over 15 years in 19 cities was 6.8% ± 4.5% and was consistent with the previous statistical data of 7% in 2018. This research demonstrated that the estimation of HBV prevalence by WBE with lamivudine as a biomarker is feasible in big cities in Southern China.