Uganda: Childhood Hepatitis B Risk High Despite Vaccine

Kampala — Despite the introduction of the Hepatitis B (HBV) birth dose vaccine in 2023, public health officials acknowledge persistent challenges in achieving optimal immunisation coverage for new-borns.

A major obstacle is the high number of births occurring outside of health facilities.

While speaking during a webinar about paediatric Hepatitis B organised by the Ministry of Health on July 12, Ruth Doreen Akuno, a nursing officer at the Uganda National Expanded Program on Immunisation (UNEPI) said that home deliveries often lack skilled birth attendants trained to administer the HBV birth dose, creating missed opportunities for crucial early vaccination.

“These unprotected new-borns are most susceptible to HBV infection during this critical window in the first few days of life,” she said, adding that further complicating matters are recurrent vaccine stock-outs that disrupt the immunisation schedule and leave infants exposed during these gaps.

“We have been experiencing a shortage of the monovalent vaccine (birth dose) and this lack of a readily available vaccine creates a race against time, with each stock-out putting countless new-borns at risk,” she said.

The World Health Organisation (WHO) recommends routine hepatitis B vaccination for all infants, beginning with a hepatitis B birth dose vaccine given within 24 hours of birth, followed by 2 or 3 additional doses within the first year of life.

In 2022, an estimated 1250 Ugandans died of the disease and around 6% of Uganda’s population remains chronically infected.

Akuno said that the Ministry of Health has acknowledged the need for a more robust approach and hinted at the development of a national strategy plan and updated treatment guidelines that are soon to be implemented.

In 2016, the WHO set a goal to eliminate hepatitis B as a public health problem and eliminate mother-to-child transmission (MTCT) of HBV by 2030. It is estimated that by 2030, 50% of all new chronic HBV infections globally will be the result of MTCT of HBV.

In 2019, the WHO African region had the highest prevalence of chronic HBV infection estimated at 2.5% among children below five years of age and it is the only region that has yet to meet WHO’s global interim goal to reduce chronic HBV prevalence to less than 1%.

According to WHO recommendation, the introduction of the HBV birth dose vaccine into a national immunisation program is a country’s first step towards protecting newborns from HBV infection and the risk of liver cancer in later life.

WHO estimates that more than 6% of the world population is infected with HBV, and research shows that 2% to 30% of cases are contracted through MTCT.

Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal.

Dr Sarah Bonita Musoke a paediatrician at Aga Khan Specialist Medical Centre says that in particular, types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths.

“In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth or through horizontal transmission, especially from an infected child to an uninfected child during the first five years of life,” Dr Musoke says.

She adds that transmission of the virus may also occur through the reuse of contaminated needles and syringes or sharp objects.

“New-borns infected with HBV through MTCT have the greatest risk of chronic HBV infection, which develops in almost 90% of children infected through this route, adding that; Infant hepatitis B vaccination, given at six, 10, and 14 weeks prevents horizontal HBV transmission, but the prevalence of HBV infection among children attributable to MTCT remains high,” she said.