rapid monitoring of hepatitis B elimination in mothers and children

The proportion of children under the age of five who are chronically infected with hepatitis B (HBV) fell to just under 1% in 2019, from about 5% in the pre-vaccination period (between the 1980s and early 2000s), according to new estimates by the World Health Organization (WHO).

This achieves one of the most important goals of viral hepatitis elimination in the goals of sustainable development ─ reaching below 1% prevalence of HBV infection in children younger than five years by 2020.

“No newborn should grow up just to die from hepatitis B because it has not been vaccinated. – Today’s milestone means we have dramatically reduced the number of cases of liver damage and liver cancer in future generations,” said Dr. Tedros Adhanom Ghebreyesus. “Preventing maternal – transmission of hepatitis B from children is the most important strategy for disease control and saving lives. Even in the midst of the COVID-19 pandemic, we must ensure that mothers and newborns have access to life-saving services, including hepatitis B vaccination.”

On World Hepatitis Day 2020, the WHO calls for united and intensified action to build on this achievement of intensive efforts to prevent mother-to-child transmission of HBV by testing pregnant women and providing antiviral prophylaxis to those in need and maintaining and expanding access to immunization against hepatitis B and the birth vaccine.

Globally, more than 250 million people live with chronic HBV infection. Infants are particularly vulnerable: about 90% of children infected with HBV in the first year of life become carriers of chronic HBV. HBV attacks the liver and requires the lives of nearly 900,000 people each year.

Prevention of hepatitis B

Infants can be protected from HBV with a safe and effective vaccine that provides over 95% protection against infection. The WHO recommends that all infants receive the first dose of hepatitis B vaccine as soon as possible after birth – preferably within 24 hours – followed by at least 2 additional doses.

The scope of the hepatitis B vaccine in the world over the past two decades, largely thanks to the support provided by Gavi, the Vaccine Alliance, has been a great success story in public health and has contributed to reducing HBV infection among children. In 2019, coverage of 3 doses of hepatitis B vaccine during childhood reached 85% worldwide, compared to about 30% in 2000. However, access to the first critical dose within 24 hours of birth remains uneven. The global coverage of this birth dose is 43%, but it drops to 34% in the eastern Mediterranean region of the WHO and only to 6% in the African region of the WHO.

“Expanding access to a timely dose for the birth of hepatitis B vaccine is the foundation of efforts to prevent mother-to-child transmission of HBV. For countries especially in regions like sub-Saharan Africa, where the native dose of hepatitis B vaccine has not yet been introduced, the priority is to ensure that protection as soon as possible, ”said Dr. Meg Doherty, director of Global HIV, Hepatitis Programs and STIs.

An additional way to protect children is to provide pregnant women with antiviral treatment to reduce mother-to-child transmission of HBV. The WHO already recommends routine testing of all pregnant women for HBV, as well as for HIV and syphilis as early in pregnancy as possible. Given the new evidence on the safety and efficacy of antiviral prophylaxis in pregnant women and their children, the WHO today publishes two new recommendations:

• Pregnant women who have tested positive for hepatitis B infection and have high levels of HBV in their blood (known as HBV viral load) should receive preventive antiviral therapy with tenofovir from group 28.^th week of pregnancy to birth. The antiviral drug tenofovir is available at low prices in many countries around the world for less than $ 3 a month.
• In environments where HBV viral load testing is not available, the WHO recommends the use of an alternative low-cost test (HBeAg) to determine if a woman is eligible for preventive antiviral therapy.

In countries that have already achieved high hepatitis B immunization coverage, including a timely birth dose, routine testing for HBV infection among pregnant women, and antiviral prophylaxis for those in need is an additional option to prevent mother-to-child transmission.

“Stopping vertical HBV transmission is a key pillar of the global ‘triple elimination’ initiative that seeks to eliminate mother-to-child transmission of the three prevalent infections in low- and middle-income countries: HIV, syphilis and hepatitis B virus,” he added. Doherty.

Eliminating mother-to-child transmission of HBV is also an important step towards achieving the goals of the WHO Global Hepatitis Strategy, which aims to reduce new hepatitis infections by 90% and deaths by 65% ​​from 2015 levels.