title: Preventing hepatitis B and hepatocellular carcinoma in South Africa: The case for a birth-dose vaccine.
abstract: Hepatitis B is a global public health issue, with some 2 billion people having current or past infection. In Africa, 65 million are chronically infected, an estimated 2.5 million of them in South Africa (SA). Hepatitis B and the associated complications of cirrhosis and hepatocellular carcinoma are entirely vaccine preventable. SA was one of the first ten countries in Africa to introduce universal hepatitis B vaccination in April 1995, but has no birth dose or catch-up programme. Although universal infant vaccination in SA has been successful in increasing population immunity to hepatitis B, improvements in terms of implementing protocols to screen all pregnant mothers for hepatitis B surface antigen (HBsAg) and ensuring full hepatitis B coverage, especially in rural areas, is justified. The World Health Organization has recommended a birth dose of hepatitis B vaccine in addition to the existing hepatitis B vaccine schedule in order to further decrease the risk of perinatal transmission. We recommend that SA implement a birth-dose vaccine into the existing schedule to attenuate the risk of perinatal transmission, prevent breakthrough infections and decrease HBsAg carriage in babies born to HIV-positive mothers.
authors.affiliation: Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. msonderup@samedical.co.za.
authors.forename: C W N
authors.initials: CW
authors.lastname: Spearman
authors.forename: Mark W
authors.initials: MW
authors.lastname: Sonderup
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000517:prevention & control* / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000517:prevention & control / Q000821:virology; D008113:Liver Neoplasms / Q000517:prevention & control / Q000821:virology; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D013019:South Africa / Q000453:epidemiology
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines