HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study

Abstract

Background: Hepatitis B is a major health concern in Africa. The vaccine against hepatitis B virus (HBV) was introduced into the Expanded Programme on Immunization (EPI) of Cameroon and Senegal in 2005, and of CAR (Central African Republic) in 2008. A cross-sectional study was conducted to assess HBV immunization coverage following the vaccine's introduction into the EPI and factors associated with having been vaccinated.

Methods: All hospitalized children, regardless of the reasons for their hospitalization, between 3 months and 6 years of age, for whom a blood test was scheduled during their stay and whose condition allowed for an additional 2 mL blood sample to be taken, and who provided the parent's written consent were included. All children anti-HBs- and anti-HBc + were tested for HBsAg. Vaccination coverage was assessed in three different ways: immunization card, maternal recall and serologic anti-HBs profile.

Results: 1783 children were enrolled between April 2009 and May 2010. An immunization card was only available for 24 % of the children. The median age was 21 months. Overall HBV immunization coverage based on immunization cards was 99 %, 49 % and 100 % in Cameroon, CAR and Senegal, respectively (p < 0,001). The immunization rate based on maternal recall was 91 %, 17 % and 88 % in Cameroon, CAR and Senegal, respectively (p < 0,001). According to serology (anti-HBs titer ≥ 10 mUI/mL and anti-HBc-), the coverage rate was 68 %, 13 % and 46 % in Cameroon, CAR and Senegal, respectively (p < 0,001). In Senegal and Cameroon, factors associated with having been vaccinated were: mother's higher education (OR = 2.2; 95 % CI [1.5-3.2]), no malnutrition (OR = 1.6; 95 % CI [1.1-2.2]), access to flushing toilets (OR = 1.6; 95 % CI [1.1-2.3]), and < 24 months old (OR = 2.1; 95 % CI [1.3-3.4] between 12 and 23 months and OR = 2.7; 95 % CI [1.6-4.4] < 12 months). The prevalence of HBV-infected children (HBsAg+) were 0.7 %, 5.1 %, and 0.2 % in Cameroon, CAR and Senegal, respectively (p < 0.001).

Conclusions: Assessing immunization coverage based on immunization cards, maternal recall or administrative data could be usefully reinforced by epidemiological data combined with immunological profiles. Serology-based studies should be implemented regularly in African countries, as recommended by the WHO. Malnutrition, lack of maternal education and poverty are factors associated with vaccine non-compliance. The countries' vaccination programs should actively address these problems.

Fig. 1

HBV immune protection (anti-HBs + ≥10 mIU/ml among anti-HBc-) according to the year of birth and the country compared to WHO coverage estimates. Y axis: percentage of immunized children