Hepatitis B Virus in Jordan: Prevalence, Incidence and Clearance From Cross-Sectional and Cohort Studies

Hepatitis B virus (HBV) infection is a global health challenge, with the World Health Organization (WHO) targeting its elimination by 2030. Jordan lacks sufficient data on HBV epidemiology, including prevalence, incidence and clearance. This study addresses these gaps through a retrospective analysis of HBV testing data from 40,268 individuals collected at Biolab Diagnostic Laboratories (2010-2024). Using cross-sectional and cohort study designs, the study examined hepatitis B surface antigen (HBsAg) prevalence, temporal trends, incidence, clearance rates and associated risk factors. Statistical methods included regression analyses, Kaplan-Meier estimations and Poisson models. HBsAg prevalence was 3.8% (95% CI: 3.6%-4.0%), with a nationally weighted prevalence of 5.3% (95% CI: 4.4%-6.4%). Prevalence was around 1% in individuals under 20 years, increasing to 8.5% (95% CI: 7.7%-10.0%) in the 50-59 age group. Over the past 15 years, prevalence declined by 7% annually [adjusted odds ratio (aOR): 0.93; 95% CI: 0.92-0.94]. HBsAg positivity was significantly associated with age, male sex and governorate. Cumulative HBsAg incidence was 0.26% (95% CI: 0.11%-0.64%) after 5 years of follow-up, with an incidence rate of 0.63 per 1000 person-years (95% CI: 0.26-1.51). Cumulative HBsAg clearance was 7.45% (95% CI: 4.07%-13.43%) at the 6-month follow-up mark, with a clearance rate of 17.68 per 100 person-years (95% CI: 9.51-32.86). Among HBsAg-positive individuals with > 6 months of follow-up, cumulative HBsAg clearance reached 46.12% (95% CI: 24.50%-74.34%) after 13 years of follow-up, with a clearance rate of 5.27 per 100 person-years (95% CI: 3.32-8.36). HBV epidemiology in Jordan shows declining prevalence and incidence, likely driven by expanding HBV vaccination coverage. To meet the WHO's 2030 elimination targets, Jordan must prioritise scaling up birth-dose vaccination, improving case detection and ensuring timely treatment.