TY - JOUR
T1 - The first five years of universal hepatitis B vaccination in South Africa
T2 - Evidence for elimination of HBsAg carriage in under 5-year-olds
AU - Tsebe, Khomotso V.
AU - Burnett, Rosemary J.
AU - Hlungwani, Nyiko P.
AU - Sibara, Mbudzeni M.
AU - Venter, Philip A.
AU - Mphahlele, M. Jeffrey
N1 - Funding Information:
We thank staff members of the Northern Province Department of Health and Welfare, as well as the students and staff members of the Department of Medical Sciences of the University of the North, for their technical support. The authors are grateful to the National Research Foundation and the National Ministry of Health, South Africa, for financial assistance.
PY - 2001/7/16
Y1 - 2001/7/16
N2 - South Africa implemented a vaccine against hepatitis B virus (HBV) into the Expanded Programme on Immunisation (EPI) in April 1995. The HBV vaccine is given at 6, 10, and 14 weeks, in parallel with OPV, DTP and Hib vaccines. This study assessed the impact of universal childhood HBV vaccination programme in reducing HBsAg carriage, in the first five years (1995-1999) since its implementation. In parallel, we investigated the current burden of HBV infection in mothers of vaccinees and the adult general population. A total of 598 babies (mean age = 23.3 months) who received 3 doses of 1.5 μg/0.5 ml Hepaccine-B (Cheil) were recruited from the Northern Province (one of the nine provinces in South Africa). HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were tested using the IMx or Axsym kits (Abbott Laboratories). PCR assays were performed following established protocols. The overall seroprotection rate (i.e. anti-HBs titre ≥ 10 mIU/ml) was 86.8% (519/598) in vaccinated babies, while 13.2% had anti-HBs levels < 10 mIU/ml. Seroprotection rates and geometric mean titres (GMT) decreased significantly with increasing age, possibly reflecting waning anti-HBs titre over time. Total HBV exposure (positive for either HBsAg, anti-HBs, or anti-HBc) was 31.0% (58/187) in mothers of vaccinees and 40% (72/180) in the adult general population. HBsAg carrier rate was virtually similar in both groups (3.2% in mothers of vaccinees vs. 3.3% in the general population). Against this background, no vaccine failures resulting in HBsAg and HBV DNA positivity were seen in vaccinated babies, including 6 babies born to HBsAg positive carrier mothers (one carrier mother was positive for HBeAg and HBV DNA). However, 0.9% (5/582) babies, aged between 8-11 months, tested positive for anti-HBc, all of whom had anti-HBs titres > 10 mIU/ml and were negative for HBV DNA. Anti-HBc positivity was probably maternal in origin, or may represent sub-clinical averted HBV infections. It can be concluded that the HBV vaccine is highly effective within the framework of the South African EPI and already shows a positive impact in the elimination of HBsAg carrier rate in children < 5 years.
AB - South Africa implemented a vaccine against hepatitis B virus (HBV) into the Expanded Programme on Immunisation (EPI) in April 1995. The HBV vaccine is given at 6, 10, and 14 weeks, in parallel with OPV, DTP and Hib vaccines. This study assessed the impact of universal childhood HBV vaccination programme in reducing HBsAg carriage, in the first five years (1995-1999) since its implementation. In parallel, we investigated the current burden of HBV infection in mothers of vaccinees and the adult general population. A total of 598 babies (mean age = 23.3 months) who received 3 doses of 1.5 μg/0.5 ml Hepaccine-B (Cheil) were recruited from the Northern Province (one of the nine provinces in South Africa). HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were tested using the IMx or Axsym kits (Abbott Laboratories). PCR assays were performed following established protocols. The overall seroprotection rate (i.e. anti-HBs titre ≥ 10 mIU/ml) was 86.8% (519/598) in vaccinated babies, while 13.2% had anti-HBs levels < 10 mIU/ml. Seroprotection rates and geometric mean titres (GMT) decreased significantly with increasing age, possibly reflecting waning anti-HBs titre over time. Total HBV exposure (positive for either HBsAg, anti-HBs, or anti-HBc) was 31.0% (58/187) in mothers of vaccinees and 40% (72/180) in the adult general population. HBsAg carrier rate was virtually similar in both groups (3.2% in mothers of vaccinees vs. 3.3% in the general population). Against this background, no vaccine failures resulting in HBsAg and HBV DNA positivity were seen in vaccinated babies, including 6 babies born to HBsAg positive carrier mothers (one carrier mother was positive for HBeAg and HBV DNA). However, 0.9% (5/582) babies, aged between 8-11 months, tested positive for anti-HBc, all of whom had anti-HBs titres > 10 mIU/ml and were negative for HBV DNA. Anti-HBc positivity was probably maternal in origin, or may represent sub-clinical averted HBV infections. It can be concluded that the HBV vaccine is highly effective within the framework of the South African EPI and already shows a positive impact in the elimination of HBsAg carrier rate in children < 5 years.
KW - Expanded Programme on Immunisation
KW - Hepatitis B vaccine
KW - Seroprotection
KW - South Africa
UR - http://www.scopus.com/inward/record.url?scp=0035898929&partnerID=8YFLogxK
U2 - 10.1016/S0264-410X(01)00120-7
DO - 10.1016/S0264-410X(01)00120-7
M3 - Article
C2 - 11427266
AN - SCOPUS:0035898929
SN - 0264-410X
VL - 19
SP - 3919
EP - 3926
JO - Vaccine
JF - Vaccine
IS - 28-29
ER -
