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[Preprint]. 2023 Nov 27:2023.11.27.23298863.
doi: 10.1101/2023.11.27.23298863.

Hepatitis B virus prevalence and transmission in the households of pregnant women in Kinshasa, Democratic Republic of Congo

Camille E Morgan  1 , Patrick Ngimbi  2 , Alix Jn Boisson-Walsh  3 , Sarah Ntambua  2 , Jolie Matondo  2 , Martine Tabala  2 , Melchior Mwandaglirwa Kashamuka  4 , Michael Emch  1 , Jessie K Edwards  1 , Kimberly A Powers  1 , Linda James  3 , Nana Mbonze  2 , Samuel Mampunza  2 , Marcel Yotebieng  5 , Peyton Thompson  6 , Jonathan B Parr  3   7
Affiliations

Hepatitis B virus prevalence and transmission in the households of pregnant women in Kinshasa, Democratic Republic of Congo

Camille E Morgan et al. medRxiv. .

Update in

Abstract

Background: Despite routine infant vaccination and blood donor screening, the Democratic Republic of Congo (DRC) has high hepatitis B virus (HBV) prevalence compared to the United States and Europe. Through the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we characterized household prevalence in DRC's capital, Kinshasa, to inform additional prevention efforts.

Methods: We introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care (ANC) in high-volume maternity clinics in Kinshasa. We recruited households of pregnant women who were HBsAg-positive and HBsAg-negative, defining households as "exposed" and "unexposed," respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates.

Results: We enrolled 1,006 participants from 200 households (100 exposed, 100 unexposed) across Kinshasa. HBsAg prevalence was more than twice as high in exposed households (5.0%; 95% CI: 2.8%-7.1%) as in unexposed households (1.9%; 0.6%-3.2%). Exposed direct offspring had 3.3 (0.9, 11.8) times the prevalence of unexposed direct offspring. Factors associated with HBsAg-positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among exposed offspring.

Conclusions: Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Keywords: PMTCT; Vertical transmission; birth-dose vaccination; horizontal transmission; viral hepatitis.

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Conflict of interest statement

Competing interests Outside the submitted work: JBP and PT report non-financial support from Abbott Laboratories (donation of hepatitis B laboratory testing and reagents for other studies), and JBP reports consulting for Zymeron Corporation. The remaining authors report no competing interests.

Figures

Figure 1.
Figure 1.. Recruitment and enrollment of households of HBsAg-positive and HBsAg-negative index mothers.
Figure 2.
Figure 2.. Enrolled households by geography and household structure.
Figure 3.
Figure 3.. Attributes and practices associated with HBsAg-positivity among index mothers (A) and exposed direct offspring (B).
Index mothers’ HBsAg result from recruitment screening used for index mothers and exposure status of direct offspring. Supplementary Material IV shows sensitivity analyses using other definitions of HBsAg positivity and exposure. Unadjusted OR shown as measure of association for index mothers due to case-control recruitment of mothers. PR adjusted for household clustering shown for direct offspring.
See this image and copyright information in PMC

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