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Preimmunization epidemiology of hepatitis B virus infection in South African children
1Department of Virology, National Institute for Virology and University of the Witwatersrand, Johannesburg, South Africa. vardase@mrc.ac.za
Insights
Hepatitis B virus (HBV) infection is highly prevalent in South African children under 6, with 10.4% testing positive for hepatitis B surface antigen (HBsAg). This study highlights a significant burden of early HBV acquisition in the Eastern Cape, underscoring the need for immunization.
Area of Science:
- Epidemiology
- Public Health
- Virology
Background:
- Hepatitis B virus (HBV) infection poses a significant global health challenge.
- Understanding HBV epidemiology in young children is crucial for effective immunization strategies.
- South Africa is implementing universal HBV immunization programs.
Purpose of the Study:
- To determine the prevalence of hepatitis B surface antigen (HBsAg) in children aged 0-6 years in the Eastern Cape, South Africa.
- To investigate the epidemiology and age of HBV infection acquisition in this pediatric population.
- To provide a pre-immunization baseline measure of HBV infection.
Main Methods:
- A community-based, cross-sectional, age-stratified sample of 2,299 children aged 0-6 years was analyzed.
- Prevalence of HBsAg was determined using serological testing.
- Statistical analysis was performed to assess age, sex, and urban/rural differences.
Main Results:
- Overall HBsAg prevalence was 10.4%, with high rates in infants (0-12 months) suggesting early acquisition.
- HBsAg positivity significantly increased with age, reaching 15.7% in the 61-72 month group.
- No statistically significant differences in prevalence were observed between urban and rural children or between males and females.
Conclusions:
- The study reveals the highest reported rate of HBV infection in community-based South African children, indicating a substantial disease burden.
- Findings suggest a higher-than-expected rate of early HBV acquisition prior to immunization.
- This data provides a critical pre-immunization baseline for evaluating the impact of HBV vaccination programs in South Africa.
Abstract:
The prevalence of hepatitis B surface antigen (HBsAg) was determined in a community-based, cross-sectional, age-stratified sample of children from 0 to 6 years of age (n = 2,299) from the Eastern Cape Province of South Africa. The purpose of the study was to investigate the epidemiology and the age of acquisition of hepatitis B virus (HBV) infection in children, thus providing a preimmunization baseline measure of this infection in the population targeted for HBV immunization in South Africa. Overall, 10.4% (95% CI, 9.2-11.7) of the children tested were HBsAg-positive. There was a high rate of positivity in the 0-6- and 7-12-month age groups at 8.1% (95% CI, 5.5-11.7) and 8.9% (95% CI, 6.1-12.7), respectively, suggesting a higher rate of early acquisition of this infection than previously reported in South Africa. The proportion of HBsAg-positive children increased significantly with increasing age (chi2trend = 5.9, df = 1, P = 0.02), reaching 15.7% in the 61-72-month age group. This is the highest rate of HBV infection reported in community-based children from South Africa, indicating a significant burden of this infection. The difference in HBsAg prevalence between urban and rural children was not statistically significant (chi2 = 0.32, df = 1, P = 0.57). There was also no difference in positivity between males (10.5%; 95% CI, 8.7-12.5) and females (9.8%; 95% CI, 8.1-11.7), (chi2 = 0.006, df = 1, P = 0.94). This study provides the most recent preimmunization, community-based baseline investigation of the epidemiology of HBV infection in children targeted for universal immunization in South Africa.