Progress towards the elimination of hepatitis B in children in Colombia: A novel two‐phase study approach

Abstract

The World Health Organization (WHO) has established a target to eliminate mother‐to‐child‐transmission (EMTCT) of hepatitis B virus (HBV), defined as a prevalence of hepatitis B surface antigen (HBsAg) of ≤0.1% among children, by 2030. Using nationally representative serosurveys to verify achievement of this target requires large sample sizes and significant resources. We assessed the feasibility of a potentially more efficient two‐phase method to verify EMTCT of HBV in Colombia. In the first phase, we conducted a risk assessment to identify municipalities at the highest risk of ongoing HBV transmission. We ranked the 1122 municipalities of Colombia based on the reports of HBV infection in pregnant women per 1000 population. Municipalities with ≥0.3 reports per 1000 persons (equating to the top quartile) were further assessed based on health facility birth rates, coverage with three doses of hepatitis B vaccine (HepB3) and seroprevalence data. Hepatitis B risk was considered to be further increased for municipalities with HepB3 coverage or health facility birth rate <90%. In the second phase, we conducted a multistage household serosurvey of children aged 5–10 years in 36 municipalities with the highest assessed HBV risk. HBsAg was not detected in any of 3203 children tested, yielding a 90% upper confidence bound of <0.1% prevalence. Coverage with HepB3 and hepatitis B birth dose was high at 97.5% and 95.6%, respectively. These results support the conclusion that Colombia has likely achieved EMTCT of HBV.

How Possible Is the Elimination of Viral Hepatitis? An Analysis Based on the Global Burden of Disease from Hepatitis B and C, 1990–2019

“…Most of the achievements in the reduction in hepatitis B incidence are due to the use of a highly effective vaccine early in childhood. In fact, some WHO regions, like Europe (EURO) and the Americas and the Caribbean (PAHO), have achieved the goals of eliminating mother-to-child transmission [ 17 ]. However, there are fewer advances for the treatment and cure of the people who were infected before the vaccine was available, which amounts to an estimate of 257 million people.…”

Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus

“…There are substantial ongoing challenges in delivery, consistency and equity of supply, maintenance of the cold chain, timely administration (particularly to babies born outside healthcare settings, in indigenous communities and in rural areas), and political acceptance of the need for HepB-BD vaccination. 95 Despite global mandates, HepB-BD has not been consistently incorporated into regional or national guidance. In 2018, the coverage remained heterogeneous, globally estimated at 43%, and as low as 4-12% for the WHO Africa Region, where only 17/47 countries have formally adopted the strategy, compared to 75% in Latin America and >80% in the Western Pacific.…”

Vertical Transmission of Hepatitis B Virus—An Update

“…A recently leading-edge study demonstrated important advances in achieving the goal of hepatitis B elimination in Colombia [ 29 ]. The study evaluated the feasibility of a two-phase approach to verify mother-to-child transmission of HBV in this country.…”

“…A total of 3203 children from these municipalities were screened for HBV infection marker. HBsAg was not detected in any of the 3203 samples, yielding an upper 90% confidence limit of <0.1% prevalence [ 29 ]. Importantly, the study reported that there are still populations in which vaccination coverage is low, such as home-born children and indigenous communities.…”