However, vaccination coverage in the world varies from 90% in the western Pacific and the Americas to 56% in southeast Asia,6 and hence the universal prevalence of HBV infection also varies widely. Highly endemic areas have 45% of infected individuals (ie, those with a prevalence ≥8%), which include China, southeast Asia, most of Africa, most Pacific Islands, parts of the Middle East, and the Amazon basin.7 In these areas, infancy or childhood is the preferred time for infection As a consequence of universal vaccination of neonates, some highly endemic countries, such as China, have overall prevalence of 7–8% and are expected to be in the intermediate prevalence category in the near
