Does Nigeria need the birth dose of the hepatitis B vaccine?

Abstract

The control of hepatitis B infection involves several strategies of which the most effective is vaccination. Schedules which include a birth dose (which can prevent vertical transmission when administered within 24 hours of birth) are recommended for use in countries with a high rate of vertical transmission. Nigeria is highly endemic for hepatitis B infection. Nigeria had hitherto utilized the monovalent HBV vaccine in the three dose schedule that includes a birth dose, the recent introduction of an HBV containing pentavalent vaccine (which cannot be administered at birth) calls to question whether there should be continued use of the birth dose of HBV (using the monovalent vaccine) in addition to three doses of the pentavalent vaccine given subsequently. This is given the fact that most infections in Nigeria are reportedly acquired in childhood through horizontal rather than vertical transmission. There is also the question of cost- effectiveness of the four dose schedule compared to the three dose schedule in the setting of Nigeria’s hepatitis B epidemiologic profile.A review of the available evidence indicates that a significant proportion of Nigerian women of child bearing age and pregnant women are seropositive for HBsAg and HBeAg. Maternal to child transmission rates of HBsAg of 47-53.3% have been documented while a significant proportion of newborns were noted to have serological markers for HBV infection before receiving their first immunization. These data indicate that there is a significant potential for vertical transmission of HBV in Nigerian infants providing a compelling reason for the continued use of the birth dose of the HBV vaccine. Cost-effectiveness was not examined in this review.There are, however, challenges to the universal delivery of the birth dose in a timely fashion. Encouraging institutional delivery, routine screening of pregnant women (with the administration of HBV within 24 hours of birth to infants of seropositive mothers), retraining of health care workers on ensuring the timely receipt of the birth dose of HBV vaccine and health education of mothers and the community on the need for immunization within 24 hours of birth are suggested strategies to improve the timely uptake of the birth dose of HBVKeywords: Birth dose, Hepatitis Bvaccine, Nigeria, Infants