Abstract
In sub-Saharan Africa, administration of hepatitis B virus (HBV) birth-dose vaccines remains suboptimal. Evidence is scarce on whether African countries should focus on increasing vaccine coverage or developing strategies incorporating additional measures, such as peripartum antiviral prophylaxis to pregnant women at high risk. To better inform decision makers, we estimated the residual risk of mother-to-child transmission despite HBV birth-dose vaccine in Cameroon. We did a single-centre, longitudinal observational study. Pregnant women were systematically screened for HBV surface antigen (HBsAg) at Tokombéré District Hospital (Tokombéré district, Cameroon). Children born to HBsAg-positive mothers in 2009-16 who received the HBV birth-dose vaccine and three subsequent doses of pentavalent vaccine at 6, 10, and 14 weeks were followed up prospectively in 2015-17. In children, capillary blood was obtained for HBsAg rapid test and dried blood spots to quantify HBV DNA concentrations. Venous blood was also collected from HBsAg-positive children. Mother-to-child transmission was confirmed by whole-genome sequencing. Between Jan 31, 2009, and Dec 31, 2016, 22 243 (66·8%) of 33 309 pregnant women accepted antenatal HBV screening, of whom 3901 (17·5%) were HBsAg positive. 2004 (51·4%) of 3901 children who were born to HBsAg-positive mothers received the HBV birth-dose vaccine, of whom 1800 (89·8%) also completed the three-dose pentavalent vaccine. In total, the current analysis included 607 children who had a follow-up serosurvey. The prevalence of HBsAg was 5·6% in children who received the birth-dose vaccine in less than 24 h, 7·0% in those who received it 24-47 h after birth, and 16·7% in those who received it 48-96 h after birth (ptrend=0·083). 35 (89·7%) of 39 infected children were born to mothers positive for HBV e antigen with high HBV DNA of 5·3 log10 IU/mL or more. Whole-genome sequencing of HBV in infected mother-child pairs confirmed high identity proportions of 99·97-100%. We documented a substantial risk of mother-to-child transmission despite timely administration of the HBV birth-dose vaccine within 24 h after birth. To reach WHO's elimination targets, peripartum antiviral prophylaxis might be required in parts of Africa, in addition to increasing coverage of the HBV birth-dose vaccine. Agence nationale de recherches sur le sida et les hépatites virales (ANRS).
Highlights
Worldwide, 296 million people are chronically infected with hepatitis B virus (HBV) and approximately 820 000 die annually due to HBV-related cirrhosis or hepatocellular carcinoma.[1]
Implications of all the available evidence This study indicated the importance of timely administration of HBV birth-dose vaccine within 24 h of birth in a real-life field condition in sub-Saharan Africa
Between Jan 31, 2009, and Dec 31, 2016, 33 309 pregnant women visited Tokombéré District Hospital, of whom 22 243 (66∙8%) were screened for hepatitis B surface antigen (HBsAg) and of whom 3901 (17∙5%) were HBsAg positive. 2004 (51∙4%) of 3901 neonates who were born to HBsAg-positive mothers received the HBV birth-dose vaccine, of whom 1800 (89∙8%) completed the three-dose pentavalent vaccine
Summary
296 million people are chronically infected with hepatitis B virus (HBV) and approximately 820 000 die annually due to HBV-related cirrhosis or hepatocellular carcinoma.[1]. To further eliminate the residual risk of mother-to-child transmission despite the infant immunoprophylaxis, WHO and other professional societies recommend peripartum antiviral prophy laxis using nucleoside or nucleotide analogues to Lancet Glob Health 2022
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