title: Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa.
abstract: In South Africa, the first HBV vaccine dose is administered at age 6 weeks, leaving a potential window for vertical transmission. Insights into HBV seroprevalence in the vulnerable HIV-infected group are important to drive improvements in surveillance, treatment and prevention.
  
  
  
  We set out to implement a screening program for HBV among HIV-infected children and adolescents in Kimberley, South Africa. Our aims were to demonstrate that screening is feasible and sustainable, to establish the prevalence of HBV, to characterise the HBV cases we identified, and to inform discussion about the infant vaccination schedule.
  
  
  
  We tested all HIV positive children (age 0-16) for Hepatitis B surface antigen (HBsAg), delivering this testing as part of routine state-funded care. We followed up HBsAg-positive cases with an extended panel of HBV serology tests, and HBV DNA viral load quantification.
  
  
  
  Our screening campaign was successfully incorporated into routine out-patient care. Among 625 patients tested, we found five positive for HBsAg (0.8%), of whom three were Hepatitis B e-antigen positive. Two additional children initially tested HBsAg-positive but were negative on repeat testing. Antiviral therapy in the HBsAg children was reviewed and adjusted if required.
  
  
  
  The results testify to the overall success of the HBV vaccine campaign. However, we have demonstrated that ongoing vigilance is required to detect cases and prevent transmission events. Further evaluation of the optimum timing of the first vaccine HBV vaccine dose is required; a vaccine dose at birth could reduce prevalence further.
authors.affiliation: Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa.
authors.forename: Pieter
authors.initials: P
authors.lastname: Jooste
authors.affiliation: Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa.
authors.forename: Anriette
authors.initials: A
authors.lastname: van Zyl
authors.affiliation: Department of Paediatrics, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Adland
authors.affiliation: Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa.
authors.forename: Samantha
authors.initials: S
authors.lastname: Daniels
authors.affiliation: Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa.
authors.forename: Louise
authors.initials: L
authors.lastname: Hattingh
authors.affiliation: Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa.
authors.forename: Alethea
authors.initials: A
authors.lastname: Brits
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Wareing
authors.affiliation: Department of Medical Microbiology and Virology, National Health Laboratory Service, University of the Free State, Bloemfontein, South Africa.
authors.forename: Dominique
authors.initials: D
authors.lastname: Goedhals
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Jeffery
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: Monique
authors.initials: M
authors.lastname: Andersson
authors.affiliation: Department of Paediatrics, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Goulder
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; Nuffield Department of Medicine, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK. Electronic address: p.matthews@doctors.org.uk.
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology* / Q000517:prevention & control*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D016036:Seroepidemiologic Studies; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: Epidemiology; HIV; Hepatitis B; South Africa; Vaccination; Viral hepatitis