In a difficult year, 2020 carried some bits of great news for global health and children around the world. The incidence of hepatitis B in children under 5 dropped below 1% in 2019, a huge milestone and a cause for celebration for the public health community around the world. WHO Director-General Tedros Adhanom Ghebreyesus spoke positively about reaching the milestone by looking to the future: “Today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations.” The milestone marks the attainment of one of the Sustainable Development Goals to reduce viral hepatitis to less than 1% prevalence for children under 5 by 2020.

Hepatitis B

Hepatitis B is a viral infection of the liver which can lead to many health problems, the most serious of which being liver cancer. More than 250 million people worldwide are carrying a chronic hepatitis B infection, with 900,000 deaths from the disease occurring annually.

Mother-to-child infection is the most common, making the disease especially damaging to children. Infants are the most vulnerable to the disease — an overwhelming 90% of infected infants under the age of 1 become chronic carriers of the disease. This makes controlling hepatitis B in children very important to global health.

Methods of Control

The best method of prevention is through the hepatitis B vaccine. The vaccine became available in 1982 and prevents millions of hepatitis B cases a year. The timing of the doses is extremely important and three are required to complete the recommended vaccination course. The first “birth dose” is most effective when administered in the delivery room or less than 24 hours after birth. The second dose should follow 28 days thereafter. The third and final dose follows at least four months after the first dose.

The WHO aims to achieve universal childhood vaccination as the vaccine offers lifetime protection for children who receive it at the recommended times. The vaccine is most effective for infants but the vaccine series is still recommended for children up to 18 years old. In 2017, the FDA approved a two-dose vaccine for adults.

Hepatitis B Vaccinations in Numbers

About 85% of children received the recommended three doses in 2019, a remarkable improvement compared to 30% who received it in 2000. The birth dose must be timely as it the most crucial part of the vaccination. This is why timely access to these vaccines is an urgent concern.

Unfortunately, despite rapid improvement, timely access to the birth dose remains unequal. Currently, 43% of children globally receive a timely birth dose. However, this falls to 34% in the eastern Mediterranean region and even further down to a lowly 6% in Africa. This serves as a reminder that, despite significant progress, efforts must continue to completely eradicate hepatitis B in children.

The Road Ahead

While the vaccine is the predominant form of prevention, recent efforts have focused on expanding ways to prevent mother-to-child transmission. The WHO called on countries to test pregnant women for hepatitis B and provide antiviral therapy before the birth of the child, if necessary. This significantly reduces the likelihood of mother-to-child transmission and is one of the key areas of improvement the WHO stresses, along with greater birth dose coverage. While hepatitis B prevention is not yet complete, reaching the 1% landmark is incredibly important and is the result of decades of hard work and effective policy.

– Clay Hallee
Photo: Flickr