Hepatitis B control among children in the Eastern Mediterranean Region of the World Health Organization

Abstract

In the pre-vaccination era, the prevalence of chronic hepatitis B virus (HBV) infection in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) ranged from two to seven percent in a total population of over 580 million people. Mortality estimates place cirrhosis among the top ten causes of years of life lost in the EMR. The region has made notable achievements, improving coverage from only 6% in 1992, when WHO recommended hepatitis B vaccination of all infants, to 83% in 2014. Member states adopted a hepatitis B control target in 2009 to reduce chronic hepatitis B virus infection prevalence to less than one percent among children aged <5 years by 2015. This report reviews progress toward achievement, challenges faced, and the next steps forward of hepatitis B control among children in the EMR.

Keywords: EMRO; HBV; Hepatitis B virus; Middle East; North Africa; Vaccination; birth dose.

Fig. 1.

Estimated prevalence of chronic hepatitis B virus infection among children in the WHO Eastern Mediterranean Region (pre-vaccine prevalence of chronic hepatitis B was previously estimated [5]. Post-vaccine prevalence estimates come from nationally representative serosurveys [Al Awaidy et al., Egypt unpublished, Sudan unpublished] or were estimated by inputting WHO-UNICEF national immunization coverage estimates for 2014 into a mathematical model [5,15].) before vaccination (a) and in 2014 (b).

Fig. 2.

Timeline of hepatitis B vaccination milestones in the WHO Eastern Mediterranean Region.

Fig. 3.

Hepatitis B vaccination coverage in the WHO Eastern Mediterranean Region, 1990–2014. Data from final WHO-UNICEF Estimates of National Immunization Coverage (July 2015). HepB3 – third dose of hepatitis B vaccine. Birth dose – hepatitis B vaccine given within 24 h of birth.