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Vaccine. 2017 May 19;35(22):2937-2942. doi: 10.1016/j.vaccine.2017.04.020. Epub 2017 Apr 20.

Early childhood transmission of hepatitis B prior to the first hepatitis B vaccine dose is rare among babies born to HIV-infected and non-HIV infected mothers in Gulu, Uganda.

Author information

1
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. Electronic address: eseremba@gmail.com.
2
Global Health Institute, University of Antwerp, Belgium.
3
Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
4
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
5
Department of Paediatrics, Gulu University School of Medicine, Gulu, Uganda.
6
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.

Abstract

BACKGROUND:

Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda.

METHODS:

We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher's exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences.

RESULTS:

We recruited 612 mothers, median age 23years (IQR 20-28). 53 (8.7%) were HBsAg-positive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6-7.0) IU/mL with 9 (17.6%) having levels≥105IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive.

CONCLUSION:

Vertical transmission does not seem to contribute substantially to the high HBV endemicity in northern Uganda. The current practice of administering the first HBV vaccine to babies in Uganda at six weeks of age may be adequate in control of HBV transmission.

KEYWORDS:

Early childhood; Hepatitis B; Transmission

PMID:
28434689
PMCID:
PMC5529605
DOI:
10.1016/j.vaccine.2017.04.020
[Indexed for MEDLINE]
Free PMC Article

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