There has been progress in reducing mother-to-child transmission of hepatitis B, but it is still lagging, particularly in Africa, according to a recent Centers for Disease Control and Prevention (CDC) report on mother-to-child transmission (MTCT). ) of hepatitis B virus (HBV).
By December 2020, 190 (98%) of the 194 member states of the World Health Organization (WHO) had introduced universal childhood vaccination with the hepatitis B (HepB) vaccine, four more countries than in 2016. During this period, there was a 10% increase in providing hepatitis B birth doses (HepB-BD) to all newborns within 24 hours of birth, up to 110 countries (57%).
The slow rise suggests that progress may have stalled, the authors write. In 2020, less than half of babies worldwide received a HepB-BD vaccine.
Rania Tohme, MD, MPH, team leader for Hepatitis B and Tetanus in CDC’s Division of Global Immunization, said Medscape Medical News: “There are still almost 50 countries that do not provide the hepatitis B birth dose, most of them in the African region…Coverage has more recently declined in 2020 and 2021 as a result of the COVID 19 pandemic, which impacted access and the use of health services.
He stressed that Africa “has the highest prevalence of hepatitis B infection in children, with more than 4 million infected with hepatitis B, representing a 2.5% prevalence of chronic infection in children under 5 years of age, which is the highest among all regions of the world.
Other regions have less than 1% prevalence of hepatitis B in children. However, “despite the increased burden in the African region, it is still lagging behind in introducing the birth dose of hepatitis B and HepB3,” Tohme said.
Hepatitis B leading cause of liver disease
HBV is the leading cause of liver cirrhosis and liver cancer in adults. The scale of the problem is enormous. If not prevented by vaccination, 90% of children will be infected at birth. There are currently 6.4 million young children with chronic HBV worldwide.
Initially, the World Health Assembly focused on three doses of the hepatitis B (HepB3) vaccine. In 2016, they set a new goal to also achieve ≥ 90% coverage with HepB-BD. The WHA aims to eliminate viral hepatitis as a public health threat by 2030. Demonstrating ≤ 0.1% prevalence of HBV surface antigen (HBsAg) among vaccinated children aged 5 years and younger would validate that its objective. In 11 countries in 2020, the prevalence of HBV surface antigen among children was less than 0.1%, the report says.
When asked why African countries lag behind other nations in vaccination, Tohme said policymakers “might not be giving it as much attention or priority as some of the other vaccine-preventable childhood diseases.” because it’s a silent infection… They’ll only start to manifest themselves in terms of liver disease, cirrhosis and cancer when they’re older… so people don’t link this to a transmission that happened during birth or childhood.”
In countries with historically low HBV prevalence, “it is important to ensure equitable access for foreign-born women to antenatal services and prevention of mother-to-child transmission interventions,” Tohme and colleagues write in the report.
Tohme said: “Countries that do not have a high prevalence of hepatitis B, in general, should be aware of screening for hepatitis B and also ensure that children are vaccinated against hepatitis B when people come from other countries.” .
He emphasized the magnitude of the problem and the urgency of improving vaccination. “There are 296 million people living with hepatitis B worldwide, including 6 million children under the age of 5,” Tohme said. “And it’s a vaccine-preventable disease. It’s the leading cause of cirrhosis and liver cancer. And if children aren’t vaccinated at birth and are infected at birth, then 9 out of 10 children will get a chronic disease and be at risk of liver cancer.
Public education is key to improving vaccination
Anna Suk-Fong Lok, MD, is assistant dean for clinical research and professor of hepatology at the University of Michigan Medical School in Ann Arbor. Lok, who was not involved in the CDC article Weekly Morbidity and Mortality Reportnoted that one of the reasons HepB-BD is not administered in many African countries is that many children are born at home, in rural areas.
Lok suggested that educating both doctors and the public was key to improving vaccination rates.
“But an audience can also be asking for things to happen,” she says. “If the public isn’t aware, they can’t be pushing, they can’t be soliciting. You can’t be asking, ‘Why doesn’t my baby get the vaccine? Or can you make sure my baby gets a shot?’ So the public has to be educated … and know that this is what the baby is going to get.”
Lok echoed that governments’ lack of willpower and resources is a barrier. Their take-home message is: “We need to do a better job. We know we have very effective means that can prevent mother-to-child transmission… If you compare 2016 and 2020, it looks like we’re not making any progress, but compared to 2000 We have made progress.”
There needs to be more focus and funding for hepatitis, Lok concluded, but with both governments and NGOs, the focus “remains on HIV, malaria and tuberculosis.”
Tohme and Lok do not report any relevant financial conflicts of interest.
MMWR. Published online July 29, 2022. Full text
Judy Stone, MD, is an infectious disease specialist and author of Resilience: a family’s story of hope and triumph over evil and of Conducting clinical research , the essential guide on the subject. You can find it in drjudystone.com or on Twitter @drjudystone .
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