Hepatitis B surface antigen seroprevalence in Morocco (2000-2024): a systematic review and meta-analysis

Hepatitis B is a silently devastating disease that presents a public health concern and affects millions of people. Recent estimates indicate that 254 million individuals globally are afflicted with chronic HBV infection, with around 1.2 million new cases emerging annually and roughly 1.1 million fatalities primarily resulting from long-term consequences. Like other developing countries, Morocco still lacks consolidated epidemiological data on the real burden of hepatitis B. In this context, our work aims to fill this gap through a systematic review and a meta-analysis of studies conducted over the last 25 years.

We conducted a comprehensive search in databases such as PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies related to Hepatitis B in Morocco. Our inclusion criteria encompass all observational studies conducted and published between 2000 and 2024 reporting HBsAg prevalence among individuals residing in Morocco regardless of age, sex, or subpopulations. The prevalence studies included were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Where appropriate, a pooled prevalence was calculated using a DerSimonian-Laird random effects model.

30 studies met the inclusion criteria, encompassing 34 cohorts and 750,784 individuals with prevalence ranging between 0.07% and 7.98%. HBsAg prevalence was assessed across four endemicity levels. About 74% of cohorts showed low prevalence (< 2%), seven studies lay in the 2-4.99% band. Only two studies reach the 5-7.99% band, while no study showed high endemicity (≥ 8%). The pooled prevalence of HBsAg in Morocco was 1.33% (95% CI: 1.07-1.61). Subgroup analysis revealed the lowest prevalence among military populations (0.36%) and the highest in vulnerable high-risk groups (5.43%), underscoring subpopulation-specific disparities in HBV burden.

The pooled prevalence observed across included studies reinforces the hypothesis that Morocco is transitioning towards a low-endemic HBV status, which reflects the comprehensive national measures, along with the positive impact of systematic vaccination of newborn introduced in 1999 and certain groups as well. However, additional efforts remain necessary to sustain this progress and adequately address the weaknesses observed at the national level in managing HBV infection, particularly among certain at-risk groups.