title: Progress towards achieving hepatitis B control in the Cook Islands, Niue, Tokelau, and Kiribati.
abstract: Hepatitis B virus (HBV) is highly endemic in many of the Pacific Island countries. Four island countries-Cook Islands, Kiribati, Niue, and Tokelau-sought to evaluate the success of their hepatitis B vaccination programs by conducting nationally representative serosurveys among children born post-vaccine introduction.
  
  
  
  Cook Islands, Niue, and Tokelau conducted school-based census serosurveys because of small populations. The Cook Islands tested children in second grade; Niue tested children in early childhood education through sixth grade; and Tokelau tested children in first through sixth grades. Because Kiribati has a much larger birth cohort, it conducted a one-stage stratified serosurvey among first grade students. All four countries tested children using the Alere Determine™ rapid point of care hepatitis B surface antigen (HBsAg) test.
  
  
  
  In the three smaller countries, no children were seropositive for HBsAg (0/245 Cook Island students, 0/183 Niuean students, 0/171 Tokelau students). In Kiribati, 39 (3.3%, 95% confidence interval 2.4-4.6%) of 1249 students were HBsAg positive. Vaccination data collected in the Cook Islands and Tokelau showed high vaccination coverage in both countries with ⩾95% birth dose coverage and 100% 3-dose coverage.
  
  
  
  The Cook Islands, Niue, and Tokelau have made remarkable progress in establishing strong vaccination programs and towards decreasing the burden of hepatitis B among children. Kiribati still needs to improve vaccination coverage to achieve the <1% HBsAg target established by the World Health Organization Western Pacific Region.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States. Electronic address: hgo9@cdc.gov.
authors.forename: Minal K
authors.initials: MK
authors.lastname: Patel
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States. Electronic address: kpw9@cdc.gov.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wannemuehler
authors.affiliation: Expanded Programme on Immunization, Cook Islands Ministry of Health, P.O. Box 109, Rarotonga, Cook Islands. Electronic address: rangi.tairi@cookislands.gov.ck.
authors.forename: Rangi
authors.initials: R
authors.lastname: Tairi
authors.affiliation: Expanded Programme on Immunization, Cook Islands Ministry of Health, P.O. Box 109, Rarotonga, Cook Islands. Electronic address: rufina.tutai@cookislands.gov.ck.
authors.forename: Rufina
authors.initials: R
authors.lastname: Tutai
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States. Electronic address: moturi@unhcr.org.
authors.forename: Edna
authors.initials: E
authors.lastname: Moturi
authors.affiliation: Expanded Programme on Immunization, Kiribati Ministry of Health & Medical Services, P.O. Box 268, Nawerewere, Tarawa, Kiribati. Electronic address: beiatabwaia@gmail.com.
authors.forename: Beia
authors.initials: B
authors.lastname: Tabwaia
authors.affiliation: Maternal and Child Health, World Health Organization Kiribati Country Office, Bikenibeu, Tarawa, Kiribati. Electronic address: nikuataa@who.int.
authors.forename: Akineti Bauro
authors.initials: AB
authors.lastname: Nikuata
authors.affiliation: Integrated Reproductive Health Coordinator, Tokelau Health Department Head Office, Nukunonu, Tokelau. Electronic address: mfepuleai.etuale@gmail.com.
authors.forename: Malae Fepuleai
authors.initials: MF
authors.lastname: Etuale
authors.affiliation: Expanded Programme on Immunization, Niue Department of Health, P.O. Box 33, Alofi, Niue. Electronic address: Grizelda.Mokoia@mail.gov.nu.
authors.forename: Grizelda
authors.initials: G
authors.lastname: Mokoia
mesh_terms: D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D010139:Pacific Islands / Q000453:epidemiology; D011114:Polynesia / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D014611:Vaccination / Q000706:statistics & numerical data
keywords: Cook Islands; Hepatitis B; Kiribati; Niue; Tokelau; Vaccination