Assessing the impact of the routine childhood hepatitis B immunization program and the need for hepatitis B vaccine birth dose in Sierra Leone, 2018. Issue 19 (26th April 2022)

• Record Type: Journal Article
• Authors: Breakwell, Lucy; Marke, Dennis; Kaiser, Reinhard; Tejada-Strop, Alexandra; Pauly, Matthew D.; Jabbi, Sonnia; Yambasu, Sahr; Kabore, Hyacinte J.; Stewart, Brock; Sesay, Tom; Samba, Thomas T.; Hayden, Tonya; Kamili, Saleem; Jambai, Amara; Drobeniuc, Jan; Singh, Tushar; Tohme, Rania A.; Wasley, Annemarie
• Is Part Of: Vaccine. Volume 40:Issue 19(2022)
• Page Start: 2741
• Page End: 2748
• Publication Date: 2022-04-26
• Subjects: Hepatitis B -- Vaccination -- Immunisation -- Vaccine preventable diseases -- Sierra Leone -- Mother-to-child transmission; HBV hepatitis B virus -- HBsAg hepatitis B virus surface antigen -- HepB hepatitis B vaccine -- HepB-BD hepatitis B vaccine birth dose -- HepB3 Three doses of hepatitis B vaccine -- WHO World Health Organization -- WUENIC WHO and UNICEF estimates of national immunization coverage -- CI Confidence interval -- IU International units -- IQR Interquartile range -- HBeAg hepatitis B virus e antigen -- MTCT Mother-to-child transmission -- SBA Skilled birth attendant -- LOD Limit of Detection -- EA Enumeration area -- total anti-HBc total antibodies to the hepatitis B virus core antigen -- U.S. CDC United States Centers for Disease Control and Prevention; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2022.03.049
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: Sierra Leone is highly endemic for hepatitis B virus (HBV) infection and thus recommends three doses of hepatitis B vaccine (HepB3) from 6 weeks of age but does not recommend a birth dose (HepB-BD) to prevent mother-to-child transmission (MTCT). We evaluated impact of the existing HepB3 schedule and risk for MTCT of HBV. We conducted a community-based serosurvey among 4–30-month-olds, their mothers, and 5–9-year-olds in three districts in Sierra Leone. Participants had an HBV surface antigen (HBsAg) rapid test; all HBsAg-positive and one HBsAg-negative mother per cluster were tested for HBV markers. We collected children's HepB3 vaccination history. Among 1889 children aged 4–30 months, HepB3 coverage was 85% and 20 (1·3% [95% CI 0·8–2·0]) were HBsAg-positive, of whom 70% had received HepB3. Among 2025 children aged 5–9 years, HepB3 coverage was 77% and 32 (1·6% [1·1–2·3]) were HBsAg-positive, of whom 56% had received HepB3. Of 1776 mothers, 169 (9·8% [8·1–11·7]) were HBsAg-positive. HBsAg prevalence was 5·9% among children of HBsAg-positive mothers compared to 0·7% among children of HBsAg-negative mothers (adjusted OR = 10·6 [2·8–40·8]). HBsAg positivity in children was associated with maternal HBsAg (p = 0·026), HBV e antigen (p < 0·001), and HBV DNA levels ≥ 200 000 IU/mL (p < 0·001). HBsAg prevalence was lower among children than mothers, for whom HepB was not available, suggesting routine infant HepB vaccination has lowered HBV burden. Since HBsAg positivity in children was strongly associated with maternal HBV infection and most of the HBsAg-positive children in the survey received HepB3, HepB-BD may prevent MTCT and chronic HBV infection.