Pandemic Disrupts Progress Toward Hepatitis B Control

Hepatitis B virus infection remains a serious health concern in Africa, and the COVID-19 pandemic disrupted efforts to reach hepatitis B control and elimination of mother-to-child transmission.

About 66% of the 1.5 million new cases of chronic HBV infection in 2019 were in the Africa region, the CDC said in a recent Morbidity and Mortality Weekly Report. Vaccination coverage has fallen short of goals to eliminate the disease as a public health threat by 2030.

“The hepatitis B birth dose vaccine, given within 24 hours of life, prevents mother-to-child transmission of the hepatitis B virus, a leading cause of liver disease and death,” Hyacinte J. Kabore, DDS, of the Vaccine-Preventable Disease Unit, World Health Organization Regional Office for Africa. told Contagion. “Every child needs a hepatitis B vaccine at birth, followed by 2 to 3 additional doses before age 1, for lifelong protection from the hepatitis B virus.”

The hepatitis B vaccine birth dose was introduced in the Africa region in 2014, but by the end of 2021 only 14 of the 47 countries in the region provided a birth dose of the vaccine as part of their routine vaccination schedule. No country in the region achieved the World Health Assembly goal to eliminate mother-to-child transmission, which accounts for most new cases.

“This research underscores the urgent need to accelerate introduction and increase coverage of the birth dose of hepatitis B vaccine in Africa, which could prevent more than 554,000 deaths in children born between 2020 and 2030, and to improve coverage with three doses of hepatitis B vaccine to prevent additional infections,” Kabore said.

All 47 countries in the region offered three doses of hepatitis B vaccine to infants by 2021, but only 16 (34%) achieved coverage of 90% or better. Only two of the countries achieved 90% or better coverage of the birth dose. Four countries achieved HBV control.

“While the results of this study are not surprising, it shows that disruptions caused by the pandemic had a negative impact on progress toward controlling hepatitis B in the African Region,” Kabore said. “In 2021, regional vaccination coverage remained low, with hepatitis B birth dose coverage at 17% and three-dose coverage at 71%.”

The pandemic disrupted immunization services in the region, and led to a drop in the number of countries with 90% or greater three-dose coverage from 20 countries in 2018 to 16 in 2021. Almost 33 million newborns in the region didn’t receive a timely birth dose in 2021.

Two countries in the region added a birth dose to their routine vaccination schedule in 2022, and 13 more announced plans to introduce it by 2025.

The report calls for the adoption of strategies such as catch-up vaccination campaigns to reach children who missed HepB vaccination during the pandemic. It also recommends promoting delivery in health care facilities, training health care workers and integrating HepB vaccination into newborn care, along with providing testing and antiviral medications for pregnant women with HBV infection who are eilbigle for treatment.

“To control hepatitis B and eliminate mother-to-child transmission in the African region, activities to scale up the introduction of hepatitis B vaccine at birth, and to increase vaccination coverage of the full hepatitis B vaccination series, are critical,” Kabore said.