Integration of hepatitis B vaccination into rural African primary health care programmes.

Abstract

Results-Vaccine coverage for hepatitis B dropped sharply from 99% to 53% to 39% for the first, second, and third doses respectively. In contrast, vaccine coverage was maintained at 97-99% for the three doses of poliomyelitis vaccine. Serological evaluation of vaccine efficacy showed that only 3-5% of recipients of all three doses failed to develop antibodies to hepatitis B surface antigen. Only 6-6% of vaccine recipients were vaccinated according to either the early or later schedules whereas 93 4% received their doses of vaccine at intervals beyond the limits of either of the planned schedules. There was, however, no significant difference in seroconversion to the surface antigen between the "unscheduled" or scheduled groups or those who were vaccinated according to the early or late schedules. The pattern of prevalence of antibodies to hepatitis B core antigen, which showed a sharp fail in children aged over 7 months, suggested that the antibodies were acquired passively rather than by active infection.Conclusions -Supplementation of the present expanded programme on immunisation with hepatitis B vaccine in rural Africa is fraught with difficulties. However, the vaccine was effective within a fairly wide spacing of dosage. Adding hepatitis B vaccine to diphtheria, tetanus, and pertussis as a tetravalent vaccine is proposed as a means of effectively integrating it into the expanded programme on immunisation in Third World settings.

Progress towards the comprehensive control of hepatitis B in Africa: a view from South Africa.

“…However, the coverage in the routine vaccination schedule for BCG inoculation during the same period was 86% and that for polio 97-99o/o. 23 In South Africa, urbanisation of black Africans has been accompanied by a substantial decline in HBV carriage. This unexpected bonus has been paralleled by a fall in the incidence of hepatocellular carcinoma.24 As shown from data obtained in Soweto,14 the decrease in the carrier rate starts with the first generation born in the urban environment.…”

Preimmunization epidemiology of hepatitis B virus infection in South African children

“…Details regarding the epidemiology of hepatitis B virus infection in children from Southern Africa has been reported in a number of published studies [Prozesky et al, 1983;Botha et al, 1984;Di Bisceglie et al, 1986;Abdool Karim et al, 1988, 1989Dusheiko et al, 1989aDusheiko et al, , 1989bJoubert et al, 1991;Schoub et al, 1991Schoub et al, , 1993Schoub, 1992]. Previous exposure to HBV as measured by HBsAg positivity ranges from 0.97% in urban black children [Di Bisceglie et al, 1986] to 25.1% in institutionalized children from Kwazulu-Natal [Abdool Karim et al, 1988].…”

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…Hepatitis B vaccination programs were not only effective in preventing perinatal and early horizontal transmission of HBV but also resulted in decreasing mortality due to fulminant hepatitis and reduced development of childhood hepatocellular carcinoma. One study in South Africa, 568 however, determined that the intervention was not effective. Some reasons for the lack of effectiveness were given, and the authors proposed that the problems they identified were likely to be faced by other programs in developing nations.…”

“…Total cost per child immunized using the Uniject device was US $6.57 vs US $7.19 using a standard disposable syringe at the health center. Schoub et al 568 South Africa; rural setting; communitybased QT All infants born in 1989 in a self-governing region of the Transvaal were immunized according to 2 schedules: (1) early schedule ϭ birth, 3 mo and 6 mo and (2) late schedule ϭ 3 mo, 4.5 mo and 6 mo. Those who were not given vaccine according to any 1 of these schedules were classified as unscheduled.…”