The WHO global health sector strategy on viral hepatitis, created in May, 2016, aims to achieve a 90% reduction in new cases of chronic hepatitis B and C and a 65% reduction in mortality due to hepatitis B and C by 2030. Hepatitis B virus (HBV) is endemic in sub-Saharan Africa, and despite the introduction of universal hepatitis B vaccination and effective antiviral therapy, the estimated overall seroprevalence of hepatitis B surface antigen remains high at 6·1% (95% uncertainty interval 4·6-8·5). In this Series paper, we have reviewed the literature to examine the epidemiology, burden of liver disease, and elimination strategies of hepatitis B in sub-Saharan Africa. This paper reflects a supranational perspective of sub-Saharan Africa, and recommends several priority elimination strategies that address the need both to prevent new infections and to diagnose and treat chronic infections. The key to achieving these elimination goals in sub-Saharan Africa is the effective prevention of new infections via universal implementation of the HBV birth-dose vaccine, full vaccine coverage, access to affordable diagnostics to identify HBV-infected individuals, and to enable linkage to care and antiviral therapy.

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ABSTRACT

Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice; 2) To assess appropriateness colonoscopy using EPAGE criteria; 3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirty-nine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%; 27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years; p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody's teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.

Aim: To determine the prevalence of HBs antigen in secondary schools, to appreciate the vaccination coverage of viral hepatitis B and to propose a vaccine catch-up strategy. Materials and Methods: This was a prospective cross-sectional study conducted over a two-month period from April 24 to June 24, 2006 among students aged 10-15, in two schools (one public and the other private) of the city of Abidjan selected at random. The assay of serum markers of viral hepatitis B of the samples collected after 5 ml peripheral venous sampling was carried out in the viral serology and bacteriology unit of the Pasteur institute of Ivory Coast using the ELISA technique (Enzyme-Linked-Immunosorbant-Assay). The ELISA technique is an enzyme immunoassay technique that can detect an antigen or an antibody by highlighting the antigen-antibody reaction. Results: Of the 282 students who participated in our study, 5.3% of students (n = 15) were infected with the hepatitis B virus. The majority of students (79.1%, n = 223) did not have no contact with the hepatitis B virus. Only 7.8% (n = 22) of the students were vaccinated against viral hepatitis B. Conclusion: The low immunization coverage and the high prevalence of seronegative students reflect the need for a vaccine catch-up policy for adolescents born before the introduction of vaccination against the viral hepatitis B virus in the Expanded Program on Immunization.