Hepatitis B infection among Nigerian children admitted to a children's emergency room

Towards contextualized complex systems approaches to scaling-up hepatitis B birth-dose vaccination in the African region: a qualitative systematic review

Background

Despite the longstanding implementation of universal hepatitis B infant vaccination programs, the World Health Organization African region (WHO AFRO) maintains the highest prevalence (2.5%) of chronic hepatitis B virus (HBV) infection among children ≤5 years of age. Scaling-up hepatitis B birth-dose (HepB BD) vaccination could avert mother-to-child transmission of HBV infection and advance regional progress towards eliminating viral hepatitis.

Objective

To describe whether - and how - complexities within the health system or intervention influence the performance of HepB BD vaccination programs in the WHO AFRO.

Methods

Using a complexity perspective, we conducted a qualitative systematic review of literature published between 2009-2022. A Boolean search strategy retrieved relevant literature indexed in PubMed, EBSCOhost databases, Scopus, and Web of Science, with supplementary searches conducted to identify any missed articles. No language restrictions were applied. Data extraction, synthesis and analysis were guided by a systems-based logic model tailored to systematic reviews of complex interventions.

Results

Our search yielded 672 published records. Of these, 28 (26 English, 2 French) were eligible for inclusion. Among the 12 WHO AFRO member states represented, the origin of evidence weighted highest in Nigeria (n = 12) and Senegal (n = 5). The performance of HepB BD vaccination programs across member states are influenced by underlying complexities across eight cross-cutting themes: (i) availability and interpretation of HepB BD vaccination policies, (ii) capacity of vaccine supply and cold chain systems, (iii) availability of equitable and sustainable financing, (iv) capacity and capability of health care workers (HCWs), (v) immunization monitoring systems and impaired feedback loops, (vi) influence of context vs system design on the timeliness of vaccination, (vii) maternal knowledge and socio-economic factors, and (viii) wider contextual factors (geography, climate, cultural practices).

Conclusion

Countries looking to introduce, or scale-up HepB BD vaccination programs will benefit from careful consideration of components of the intervention design that are dependent on the end-user's context and capabilities in accessing the vaccine; the adherence and interpretation of essential components of the policy; the provision of adequate support of stakeholders specifically HCWs and government ministries; and the need for innovative approaches to underlying complexities. Lessons offered by these African experiences provide pragmatic approaches to successfully implementing HepB BD vaccination programs in the region.

Knowledge and Willingness to Utilize Hepatitis B Preventive Measures among Pregnant Women in Ado-Ekiti, Southwest, Nigeria

Introduction

Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection.

Objectives

This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria.

Methods

This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection.

Results

Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001).

Conclusion

This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.

Timeliness in the uptake of hepatitis B birth dose among Indian children under age five: A population-based study

OBJECTIVE

To assess the timeliness and risk factors for the delay in the uptake of the hepatitis B birth dose among Indian children aged 0-59 months. Information regarding whether the children received the birth dose and the time of receiving it was recorded based on the vaccination card available at the time of the National Family Health Survey (NFHS).

METHODS

Using data from the fourth and fifth round of India's National Family Health Survey (NFHS), the percentage of uptake and timely receipt of the hepatitis B birth dose were obtained by background characteristics and at the sub-national level (state). Multinomial logistic regression analysis was used to examine the risk factors. This study further performed a negative binomial regression estimation to predict the probability of receiving the birth dose at each day within a multivariable framework.

RESULTS

It was found that approximately 34 % of the children who received the birth dose and the timing of receiving the birth dose was made available through the vaccination card were administered the dose within 24-hours during 2015-16. However, the percentage increased to 51.91 % during 2019-21. During 2019-21, Ladakh had the highest proportion (85.03 %) of children receiving the dose within 24-hours, followed by Jammu & Kashmir with 78 %, and Arunachal Pradesh with 68 %. Mother's education, economic status of the child's family and region (children belong from) were found to be significant predictors in delay of receiving the birth dose within 24 hours.

CONCLUSION

Results indicated a need for targeted interventions to improve the coverage and timeliness in the uptake of this critical vaccine dose in the country. These interventions could include strategies such as strengthening the healthcare system, improving awareness among parents and healthcare providers, addressing logistical challenges in vaccine delivery, and promoting community engagement and education on importance of timely vaccination.

A Systematic Review and Meta-Analysis of the Prevalence of Triplex Infections (Combined Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus) among Pregnant Women in Nigeria

Objective

We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy.

Methods

To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I² was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583.

Results

Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02-0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06-0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:-0.00-0.00; 1451 women; P < 0.001) in general obstetric population. Moreover, there was a significant difference in the pooled prevalence between studies published between 2001 and 2010 and between 2011 and 2021 (0.14% (95% CI: 0.12 to 0.16 versus 0.03% (95% CI: 0.02 to 0.04%; P < 0.001))) and participants recruited in the period between 2001 and 2011 and between 2012 and 2021 (0.13% (95% CI: 0.05 to 0.21; p=0.002 versus 0.00% (95% CI: -0.00 to 0.00%; p=1.00))), respectively.

Conclusion

The combined prevalence of prenatal triplex infections was 0.03%, with rates notably higher among the group of pregnant women who were HIV-positive and during the recruitment period that took place before 2012. This prevalence still necessitates screening for these infections as necessary.

Case control study of CD4 cell count and some haematological parameters among hepatitis and non-hepatitis B patients in Oyo State, South-west, Nigeria

Aim

Hepatitis B virus HBV infection is a major cause of chronic liver disease worldwide. CD4 count and haematological parameters (HPs) could be used to monitor the health status of hepatitis B (HB) individuals. This study aimed at assessing levels of CD4 count and some HPs among sufferers of HB patients and controls.

Methods

Fifty (50) HB patients as cases and 50 age-matched controls were recruited into the study. 5ml of whole blood sample was collected from all eligible participants of which 20µl and 10µl were used for CD4 count and HPs analysis respectively. Pearson correlation analysis was used to assess statistical difference within them using SPSS version 20.

Results

There was significant increase between the normal values of the CD4 count of both cases and controls (p<0.05). Significant correlations were found in some HPs such as HCT with WBC; HB and RBC with PLT; RBC, HCT and PLT with WBC.

Conclusion

There were no significant differences between the values of the CD4 count and hematological parameters among HB subjects in this study. There is need for future studies to detect changes in CD4 count and other HPs in HB patients to increase options of screening for immunological changes during management.

Hepatitis B Virus in West African Children: Systematic Review and Meta-Analysis of HIV and Other Factors Associated with Hepatitis B Infection

While Hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are endemic in West Africa, the prevalence of HBV/HIV coinfection and their associated risk factors in children remains unclear. In this review, we sought to assess HBsAg seroprevalence among 0- to 16-year-olds with and without HIV in West African countries and the risk factors associated with HBV infection in this population. Research articles between 2000 and 2021 that reported the prevalence of HBV and associated risk factors in children in West Africa were retrieved from the literature using the Africa Journals Online (AJOL), PubMed, Google Scholar, and Web of Science databases as search tools. StatsDirect, a statistical software, was used to perform a meta-analysis of the retained studies. HBV prevalence and heterogeneity were then assessed with a 95% confidence interval (CI). Publication bias was evaluated using funnel plot asymmetry and Egger's test. Twenty-seven articles conducted across seven West African countries were included in this review. HBV prevalence among persons aged 0 to 16 years was 5%, based on the random analysis, given the great heterogeneity of the studies. By country, the highest prevalence was observed in Benin (10%), followed by Nigeria (7%), and Ivory Coast (5%), with Togo (1%) having the lowest. HBV prevalence in an HIV-infected population of children was (9%). Vaccinated children had lower HBV prevalence (2%) than unvaccinated children (6%). HBV prevalence with a defined risk factor such as HIV co-infection, maternal HBsAg positivity, undergoing surgery, scarification, or being unvaccinated ranged from 3-9%. The study highlights the need to reinforce vaccination of newborns, screening for HBV, and HBV prophylaxis among pregnant women in Africa, particularly in West Africa, to achieve the WHO goal of HBV elimination, particularly in children.

Prevalence of hepatitis B virus infection among children attending the outpatient clinic of a tertiary health centre in Southwest Nigeria

Introduction

hepatitis B virus (HBV) infection is a global health disease. One-third of the world´s population is reportedly infected with the virus. Infections in children are mostly perinatal and therefore acquired early in life, with a propensity to evolve into chronic diseases and their attendant life-threatening complications. Early diagnosis can, however, improve outcomes in this group of children. The study aimed to determine the prevalence of HBV among children attending the outpatient clinic of a tertiary hospital in Southwest Nigeria.

Methods

we recruited a total of one hundred and ninety-eight children aged 6 months to 18 years from the children´s outpatient clinic of a tertiary health centre, using the systematic sampling technique. HBsAg was tested using the HBsAg test kit (PRO-med®, China), and the anti-HBs antibody was tested using the ELISA method. Data were analysed using SPSS version 26.

Results

of the 198 children that were screened, 2 (1.0%) were positive. Of these, one (50.0%) had a Hepatitis B positive mother and was HBeAg positive. Two-thirds of the children had received the hepatitis B vaccine, as evidenced by caregivers´ recall, or sighting of the immunization record. There was no statistically significant relationship between the hepatitis B status of the children and the sociodemographic parameters.

Conclusion

the study supports the fact that paediatric HBV infections are transmitted from mother to child. Though the prevalence of HBsAg in the study population was lower than the national average for the country, routine immunization program should be strengthened for further control of HBV. Age and gender were not significantly associated with HBV infection in this study.

Factors associated with receipt of a timely infant birth dose of hepatitis B vaccine at a tertiary hospital in North-Central Nigeria

The World Health Organization recommends universal vaccination of medically stable infants with Hepatitis B vaccine within 24 hours of birth to prevent mother-to-child transmission of Hepatitis B virus (HBV) infection. However, the proportion of infants who receive a timely birth dose is extremely low in Nigeria. We reviewed the implementation of an infant HBV vaccine schedule at a single center and identified factors affecting the receipt of a timely birth dose of HBV vaccine. We conducted a retrospective cohort study utilizing data from the INFANT study, a 2013-2017 prospective cohort study of pregnant women with and without HIV and their infants We utilized bivariate and multivariable logistic regression to assess if maternal characteristics, or the day of the week on which the infant was born were significantly associated with timely receipt of a birth dose of HBV vaccine. Receipt of HBV vaccine on the day of birth or the following calendar day were considered a timely birth dose. Among 409 infants in our cohort, 133 infants (33%) received a timely birth dose of HBV vaccine. Only the day of the week on which infants were born was significant (p<0.0001): when compared to Friday, infants born Monday through Thursday had significantly higher odds of receiving a timely birth dose, while infants born on a Saturday or Sunday had similar (low) odds. We found no association between maternal age, education, marital status, HIV status, parity and mode of delivery, and infant receipt of a timely birth dose of HBV vaccine. National immunization programs could improve timely HBV birth dose rates by providing access to vaccine immediately following birth at all infant delivery venues on all days of the week. Where not possible, there should be rapid linkage to the nearest facility where HBV vaccination is immediately available.

Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps

Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.

Association between ABO and RH blood groups and Hepatitis B virus infection among young Nigerian adults

BACKGROUND

Several diseases are reported to be associated with ABO/Rh blood groups. Data on the association between ABO and Rh D blood group antigens in the Nigerian population is sparse. This study aimed at determining the prevalence of Hepatitis B Virus (HBV) infection as well as its association with ABO and Rh D antigens among young Nigerian adults.

METHODS

Whole blood was collected from 496 students and screened for the presence of HBsAg using an immuno-chromatographic technique. The ABO and Rh D antigen status of participants were also determined using standard techniques.

RESULTS

In this study, the prevalence of HBV infection was 10/496 (2.10%). Of all factors assessed, only age of participants was identified as a risk factor (P < 0.05) for HBV seropositivity. Over half 257/496 (51.5%) of subjects were of the blood group O type, while 18/496 (3.6%) were of the AB blood type which was the least in occurrence. Rh D negative blood group was observed among 24/496 (4.8%) subjects. Those with the B blood type were observed to have an insignificantly (P > 0.05) higher prevalence of HBV infection. However, with respect to Rh D antigen alone, participants negative for the antigen were observed to have a five times higher risk of acquiring HBV infection than those positive for it (OR = 5.273, 95% CI = 1.056, 26.321, P > 0.05). Combining the ABO and Rh blood group systems, an association (OR = 20.174; P > 0.05) was found to exist between B Rh D negative status and HBV infection.

CONCLUSION

Possession of B antigen without Rh D antigen is associated with increased risk of acquiring HBV infection.

Hepatitis B virus infection in Nigeria: a systematic review and meta-analysis of data published between 2010 and 2019

Background

Hepatitis B virus (HBV) is an infectious disease of global significance, causing a significant health burden in Africa due to complications associated with infection, such as cirrhosis and liver cancer. In Nigeria, which is considered a high prevalence country, estimates of HBV cases are inconsistent, and therefore additional clarity is required to manage HBV-associated public health challenges.

Methods

A systematic review of the literature (via PubMed, Advanced Google Scholar, African Index Medicus) was conducted to retrieve primary studies published between 1 January 2010 and 31 December 2019, with a random-effects model based on proportions used to estimate the population-based prevalence of HBV in the Nigerian population.

Results

The final analyses included 47 studies with 21,702 participants that revealed a pooled prevalence of 9.5%. A prevalence estimate above 8% in a population is classified as high. Sub-group analyses revealed the highest HBV prevalence in rural settings (10.7%). The North West region had the highest prevalence (12.1%) among Nigeria’s six geopolitical zones/regions. The estimate of total variation between studies indicated substantial heterogeneity. These variations could be explained by setting and geographical region. The statistical test for Egger’s regression showed no evidence of publication bias (p = 0.879).

Conclusions

We present an up-to-date review on the prevalence of HBV in Nigeria, which will provide critical data to optimise and assess the impact of current prevention and control strategies, including disease surveillance and diagnoses, vaccination policies and management for those infected.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06800-6.

Prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos, Nigeria

INTRODUCTION

The study was carried out to determine the prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos.

METHOD

A cross-sectional study conducted to determine the prevalence and risk factors for hepatitis B and C viral co-infection in children aged 2 months to 13 years. There were 187 HIV infected and 187 HIV naïve age, sex-matched controls. Blood samples of participants were assayed for the serologic markers [HBsAg, anti-HBc, and anti-HCV)] of HBV and HCV viral infections using the Enzyme-Linked Immunosorbent assay (ELISA) method.

RESULT

The prevalence of HBV infection using HBsAg was 5.3% and 4.8% (p = 0.814), among HIV-infected and HIV naïve children respectively, while using anti-HBc the prevalence was 7.0% and 7.5% (p = 0.842) among HIV- infected and HIV naïve children respectively. The prevalence of HCV infection among HIV- infected and HIV naive children were equal to 0.5% (p = 1.000). There was also no significant association with the identifiable risk factors (sharing of a toothbrush, sharing of needles, incision marks/tattoo, hepatitis B immunization status, history of blood transfusion, previous surgical operation, sexual exposure/abuse, history of jaundice, and genital circumcision) and the HBV and or HCV status among both groups of children. History of sexual exposure/abuse and history of jaundice were however found to be predictors of the presence of HBsAg among HIV infected children only, using a binary logistic regression model.

CONCLUSION

The prevalence of HBV and or HCV infection among HIV-infected children is similar to the prevalence among HIV naïve children, suggesting that HIV-infected children are not more predisposed to viral hepatitis than healthy children. Also, there was no significant difference in the prevalence of HBV infection irrespective of the use of HBsAg or anti-HBc.

Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0-1 after birth were 14.2% (95% CI: 10.1-18.9) for BCG and 1.3% (0.0-4.5) for HepB-BD. No data were available for OPV0 at day 0-1. The coverage at day 28 was 71.7% (63.7-79.2) for BCG, 60.8% (45.8-74.7) for HepB-BD, and 76.1% (67.1-84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.

Pattern of prevalent Hepatitis B virus genotypes in Zaria, Nigeria

Background:

Hepatitis B virus (HBV) is hyperendemic in Nigeria. Available literature reveal genotype E as being predominant in West Africa. This study aimed at identifying the current pattern and prevalent genotypes of HBV in Zaria, Nigeria.

Materials and Methods:

Four millilitre of blood was collected in ethylenediaminetetraacetic acid-container from each of 165 HBV surface antigen-positive participants recruited purposively from the gastroenterology clinic from May to August, 2017. Plasma was separated and frozen at −20°C till analysis. Multiplex-nested polymerase chain reaction using type-specific primers was used to identify the various HBV genotypes.

Results:

Median (and interquartile range ) age of the participants was 31.0 (25.5–39.0) years, with males constituting 107 (64.8%). Majority (83.6%) of the samples analysed were HBV-DNA-positive with 82.6% of the HBV-DNA-positive samples being mixed genotype infections. Irrespective of mode of occurrence, five HBV genotypes were identified with HBV/E (97.1%) being the most predominant, followed by HBV/B (82.6%), HBV/A (24.6%), then HBV/C (17.4%), while HBV/D (0.7%) was the least prevalent.

Conclusion:

In most (99.1%) of the mixed-infection were a combination of genotype E, the predominant genotype, with other genotypes predominantly genotype B. HBV genotypes E, B, A, C and D are the prevalent genotypes in Zaria, Nigeria, as they occur in single genotype and in mixed-genotypes pattern.

Hepatitis B virus (HBV) infection amongst children in Senegal: current prevalence and seroprotection level

Introduction

Hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal.

Methods

Between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels ≥ 10 IU/l) were considered as seroprotected against HBV.

Results

During the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb ≥ 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb ≥ 100 IU/L.

Conclusion

Our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal.

Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature

BACKGROUND

Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria.

OBJECTIVE

To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria.

METHODS

A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers.

RESULTS

24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3-15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis.

CONCLUSION

The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.

The status of hepatitis B control in the African region

The World Health Organization (WHO) African Region has approximately 100 million people with chronic hepatitis B virus (HBV) infection. This review describes the status of hepatitis B control in the Region. We present hepatitis B vaccine (HepB) coverage data and from available data in the published literature, the impact of HepB vaccination on hepatitis B surface antigen (HBsAg) prevalence, a marker of chronic infection, among children, HBsAg prevalence in pregnant women, and risk of perinatal transmission. Lastly, we describe challenges with HepB birth dose (HepB-BD) introduction reported in the Region, and propose strategies to increase coverage. In 2015, regional three dose HepB coverage was 76%, and 16(34%) of 47 countries reported ≥ 90% coverage. Overall, 11 countries introduced HepB-BD; only nine provide universal HepB-BD, and of these, five reported ≥ 80% coverage. From non-nationally representative serosurveys among children, HBsAg prevalence was lower among children born after HepB introduction compared to those born before HepB introduction. However, some studies still found HBsAg prevalence to be above 2%. From limited surveys among pregnant women, the median HBsAg prevalence varied by country, ranging from 1.9% (Madagascar) to 16.1% (Niger); hepatitis B e antigen (HBeAg) prevalence among HBsAg-positive women ranged from 3.3% (Zimbabwe) to 28.5% (Nigeria). Studies in three countries indicated that the risk of perinatal HBV transmission was associated with HBeAg expression or high HBV DNA viral load. Major challenges for timely HepB-BD administration were poor knowledge of or lack of national HepB-BD vaccination guidelines, high prevalence of home births, and unreliable vaccine supply. Overall, substantial progress has been made in the region. However, countries need to improve HepB3 coverage and some countries might need to consider introducing the HepB-BD to help achieve the regional hepatitis B control goal of < 2% HBsAg prevalence among children < 5 years old by 2020. To facilitate HepB-BD introduction and improve timely coverage, strategies are needed to reach both facility-based and home births. Strong political commitment, clear policy recommendations and staff training on HepB-BD administration are also required. Furthermore, high quality nationally representative serosurveys among children are needed to inform decision makers about progress towards the regional control goal.

Hepatitis B vaccination timing: results from demographic health surveys in 47 countries

Objective

To examine the impact of hepatitis B vaccination schedules and types of vaccines on hepatitis B vaccination timing.

Methods

We used data for 211 643 children from demographic and health surveys in 47 low- and middle-income countries (median study year 2012). Data were from vaccination cards and maternal interviews. We grouped countries according to the vaccination schedule and type of vaccine used (monovalent or combination). For each country, we calculated hepatitis B vaccination coverage and timely receipt of vaccine doses. We used multivariable logistic regression models to study the effect of vaccination schedules and types on vaccination delay.

Findings

Substantial delays in vaccination were observed even in countries with fairly high coverage of all doses. Median delay was 1.0 week (interquartile range, IQR: 0.3 to 3.6) for the first dose (n = 108 626 children) and 3.7 weeks (IQR: 1.4 to 9.3) for the third dose (n = 101  542). We observed a tendency of lower odds of delays in vaccination schedules starting at 6 and at 9 weeks of age. For the first vaccine dose, we recorded lower odds of delays for combination vaccines than for monovalent vaccines (adjusted odds ratio, aOR: 0.76, 95% confidence interval, CI: 0.71 to 0.81).

Conclusion

Wide variations in hepatitis B vaccination coverage and adherence to vaccination schedules across countries underscore the continued need to strengthen national immunization systems. Timely initiation of the vaccination process might lead to timely receipt of successive doses and improved overall coverage. We suggest incorporating vaccination timing as a performance indicator of vaccination programmes to complement coverage metrics.

Barriers to timely administration of birth dose vaccines in The Gambia, West Africa

OBJECTIVE

Although vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6-12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia.

METHODS

We used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0-1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014.

RESULTS

Most of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR)=6.13, 95%CI: 3.20-11.75, east rural: AOR=6.72, 95%CI: 3.66-12.33) and maternal education (senior-educations: AOR=2.43, 95%CI: 1.17-5.06); and inversely associated with distance to vaccination delivery points (≧2km: AOR=0.41, 95%CI: 0.24-0.70), and Fula ethnicity (AOR=0.60, 95%CI: 0.40-0.91).

CONCLUSION

Vaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.

Seroprevalence and Risk Factors of Hepatitis B Virus Infection among Adolescents in Enugu, Nigeria

OBJECTIVES

The aim of the study was to determine the prevalence and correlates of hepatitis B virus infection in adolescents in Enugu-urban.

METHODS

A cross-sectional seroprevalence survey was conducted among school children aged 10-18 years. Subjects were selected using multistage sampling. Hepatitis B surface antigenaemia (HBsAg) was assayed for in blood using rapid enzyme-linked immunosorbent assay kits. Data were analyzed using statistical package for social sciences version 16.0 (p < 0.05).

RESULTS

Four hundred and twenty children were recruited. Of these, 13 tested positive for HBsAg, giving an overall hepatitis B seroprevalence of 3.1%. Social class, scarifications/tattooing, circumcision and history of surgery were the significant modes of transmission.

CONCLUSION

The seroprevalence of hepatitis B among children in the study population is high. Its screening in school children should be incorporated into school health services in our setting while awareness campaigns and health education on its modes of transmission and prevention should be promoted and strengthened.