title: Effectiveness of hepatitis B virus vaccination program in Egypt: Multicenter national project.
abstract: OBJECTIVE
  To assess the effectiveness of hepatitis B virus (HBV) vaccination program among fully vaccinated children.
  
  
  METHODS
  A national community based cross-sectional study was carried out in 6 governorates representing Egypt. A total of 3600 children aged from 9 mo to 16 years who were fully vaccinated with HBV vaccine during infancy were recruited. Face to face interviews were carried out and sera were evaluated for hepatitis B surface antigen (HBsAg), anti-HBV core antibodies (total) and quantitative detection of hepatitis B surface antibody using enzyme linked immunoassays techniques. Samples positive to HBsAg/anti-HBV core antibodies were subjected to quantitative HBV-DNA detection by real time polymerase chain reaction with 3.8 IU/L detection limit.
  
  
  RESULTS
  Sero-protection was detected among 2059 children (57.2%) with geometric mean titers 75.4 ± 3.6 IU/L compared to 3.1 ± 2.1 IU/L among non-seroprotected children. Multivariate logistic analysis revealed that older age and female gender were the significant predicting variables for having non sero-protective level, with adjusted odds ratio 3.3, 9.1 and 14.2 among children aged 5 to < 10, 10 to < 15 and ≥ 15 years respectively compared to those < 5 years and 1.1 among girls compared to boys with P < 0.01. HBsAg was positive in 0.11% and breakthrough infection was 0.36% and 0.39% depending on positivity of anti-HBc and DNA detection respectively. The prevalence of HBV infection was significantly higher among children aged ≥ 7 years (0.59%) compared to 0.07% among younger children with odds ratio equal to 8.4 (95%CI: 1.1-64.2) and P < 0.01.The prevalence was higher among girls (0.48%) than boys (0.29%) with P > 0.05.
  
  
  CONCLUSIONS
  The Egyptian compulsory HBV vaccination program provides adequate protection. Occult HBV infection exists among apparently healthy vaccinated children. Adherence to infection control measures is mandatory.
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Iman I
authors.initials: II
authors.lastname: Salama
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Samia M
authors.initials: SM
authors.lastname: Sami
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Zeinab Nabil Ahmed
authors.initials: ZN
authors.lastname: Said
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Manal H
authors.initials: MH
authors.lastname: El-Sayed
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Lobna A
authors.initials: LA
authors.lastname: El Etreby
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Thanaa M
authors.initials: TM
authors.lastname: Rabah
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Dalia M
authors.initials: DM
authors.lastname: Elmosalami
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Amany T
authors.initials: AT
authors.lastname: Abdel Hamid
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Somaia I
authors.initials: SI
authors.lastname: Salama
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Aida M
authors.initials: AM
authors.lastname: Abdel Mohsen
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Hanaa M
authors.initials: HM
authors.lastname: Emam
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Safaa M
authors.initials: SM
authors.lastname: Elserougy
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Amal I
authors.initials: AI
authors.lastname: Hassanain
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Naglaa F
authors.initials: NF
authors.lastname: Abd Alhalim
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Fatma A
authors.initials: FA
authors.lastname: Shaaban
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Samia A
authors.initials: SA
authors.lastname: Hemeda
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Nihad A
authors.initials: NA
authors.lastname: Ibrahim
authors.affiliation: Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt.
authors.forename: Ammal M
authors.initials: AM
authors.lastname: Metwally
keywords: Breakthrough infection; Children; Hepatitis B virus; Immunization; Sero-protection