Children in Africa face a threat that most children around the world no longer face: hepatitis B. The disease, caused by hepatitis B virus, or HBV, spreads from mother to child at the time of birth. The virus initially causes few or no symptoms, then lives silently for decades in the liver, causing progressive damage that can lead to early death. Among children infected at birth, one in four are at risk of early death from liver failure or liver cancer.
“Africa has inadequate surveillance systems for HBV, so the burden is poorly understood. The silent nature of the infection results in most cases going undiagnosed until it is too late,” said Dr. Henry Njuguna, an epidemiologist at the Coalition for Global Hepatitis Elimination, or CGHE.
The Coalition for Global Hepatitis Elimination
The Coalition for Global Hepatitis Elimination at the Task Force for Global Health provides services to assist in the planning, implementation and evaluation of national and subnational programs to eliminate hepatitis B and C virus transmission and disease through advocacy, technical assistance, research, knowledge generation, and dissemination among partners united in a community of practice. Join our efforts: https://www.globalhep.org/contact-us
A safe and effective vaccine prevents HBV infection. For newborns, the vaccine offers 75–95% protection. Unfortunately, fewer than one in five newborns in Africa are vaccinated. “We must act now, improve hepatitis B vaccination for newborns, and save 500,000 children this decade from an early death caused by HBV,” said Njuguna. “Given the safety and effectiveness of the vaccine, we must take this tremendous opportunity to save Africa’s future generations from unnecessary losses and suffering from hepatitis B.”
HBV vaccination of newborns combined with screening to identify pregnant women infected with the virus prevents the spread of the disease even further. “With the detection of hepatitis B infection among pregnant women, women with high amount of HBV in their blood can be given antiviral medication to reduce the amount of virus, decreasing the risk of transmission,” Njuguna explained.
In a conversation with Devex, Njuguna elaborated on the preventative measures that can be taken to halt the burden of hepatitis in African children, and what CGHE is doing to support this effort.
This conversation has been edited for length and clarity.
How do strategies for eliminating mother-to-child transmission of HBV fit in with the United Nation’s targets for combatting viral hepatitis and the World Health Organization member states’ Global Health Sector Strategy on viral hepatitis, which calls for the elimination of viral hepatitis as a public health threat by 2030?
The U.N. set interim and final goals for the elimination of hepatitis B among young children. The African region is the only region that failed to reach the interim target. Compared to other regions, the prevalence of hepatitis B is more than threefold greater for children in Africa. We must work to vaccinate 90% of children in Africa against hepatitis B beginning at birth, followed by completion of the three-dose series as infants. With this level of hepatitis B vaccination coverage in Africa, we will save 550,000 African children born this decade from liver failure and liver cancer.
Where does Africa stand in the effort to eliminate mother-to-child transmission?
Africa trails other regions with one in five newborns receiving the birth dose vaccine. Only 14 of 47 countries in the African region have introduced the HepB-BD vaccine into their immunization programs. Even in countries with a policy, the HBV vaccination rate of newborns is low.
Many countries in Africa have low awareness of the health threats of HBV and the benefits of vaccination, delaying the development of newborn vaccination policies. Funding to implement birth dose vaccination is also an issue. That said, a small number of African countries have introduced policies for HBV vaccination, demonstrating that broad adoption of this life-saving intervention is possible.
How does screening pregnant women for HBV add an extra layer of protection, and help protect the health of infected women?
Screening during pregnancy provides an opportunity to identify pregnant women with HBV who are at risk of transmitting the virus to their babies at birth. Pregnant women with a high amount of HBV in their blood can be given antiviral medication to decrease the risk of transmission. In addition, the baby should be given a dose of the vaccine within 24 hours after birth, or within 12 hours if a woman is known to be positive.
Screening pregnant women can also help women with HBV receive the care and treatment they need to prevent liver damage and cancer. Although not curative, the severe outcomes of liver disease, including liver cancer, are markedly reduced with antiviral medication.
Screening of families of pregnant women with hepatitis B can identify those who can benefit from hepatitis B vaccination or hepatitis B care and treatment. If one family member is infected with HBV, there is an up to 50% chance that others in the family will become infected. At this present time, services to protect African families from hepatitis B are rare.
Can you tell us more about what CGHE is doing to eliminate HBV mother-to-child transmission in Africa?
The Coalition is tackling several barriers to hepatitis elimination. Because there is a lack of awareness of hepatitis B among communities, especially pregnant women, the Coalition supports grassroots and government efforts to provide culturally sensitive information on the need for HBV testing during pregnancy and the importance of vaccination to prevent mother-to-child-transmission. We are also informing health care workers on strategies to ensure timely administration of the birth dose vaccine and advocating for HepB-BD introduction among policymakers. We have also developed a birth dose toolkit for national immunization technical advisory groups. The toolkit provides background, data, and best practices for introducing a birth dose program in African countries.
Another problem is a lack of information sharing between various stakeholders. The Coalition convenes a community of practice to share experiences and best practices for introducing and enhancing HepB-BD vaccination across countries and to identify needs for technical assistance. The community of practice has identified some of the key barriers to HepB-BD vaccine implementation in Africa, in particular, the lack of political will arising from poor understanding about the high burden of HBV infection.
Finally, a lack of timely and accurate data leads to delays in decision-making when it comes to implementing national vaccination plans. The Coalition works with local stakeholders to develop comprehensive profiles and country-level data dashboards for use in planning, advocacy, and resource mobilization efforts.
Do you have a call to action to share with the global development community?
It’s urgent that all parties who are invested in improving maternal and child health in Africa join the Coalition’s efforts to stop the spread of hepatitis B among Africa’s children. We must work with health officials, clinicians and communities to increase awareness about the high and increasing burden of HBV infection and increase availability and demand for the vaccine. Health care workers are important stakeholders to deliver a timely dose of HepB-BD vaccination. We also need to address funding challenges by breaking silos and leveraging existing infrastructure, such as systems for HIV screening, care and treatment. Finally, Gavi, the Vaccine Alliance, needs to implement its promise to support the HepB-BD implementation, an activity they put on hold due to the COVID-19 pandemic.
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