Prevention of materno-foetal transmission of hepatitis B in sub-Saharan Africa: the evidence, current practice and future challenges

Authors

  • J. Howell,

    Corresponding author
    1. Department of Medicine, Imperial College London, London, UK
    2. Department of Hepatology, St Mary's Hospital, London, UK
    3. The Macfarlane-Burnet Institute, Melbourne, Vic., Australia
    4. Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
    • Correspondence: Jessica Howell, Department of Medicine, St Mary's Hospital, Level 10, QEQM Building, South Wharf Rd, London W2 1NY, UK.

      E-mail: jhowell@imperial.ac.uk

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  • M. Lemoine,

    1. Department of Medicine, Imperial College London, London, UK
    2. Department of Hepatology, St Mary's Hospital, London, UK
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  • M. Thursz

    1. Department of Medicine, Imperial College London, London, UK
    2. Department of Hepatology, St Mary's Hospital, London, UK
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Summary

Hepatitis B (HBV) infection is highly endemic in sub-Saharan Africa (SSA), where more than 8% of the population remain chronic HBV carriers. SSA has one of the highest HBV-related liver cancer rates in the world (CA Cancer J Clin, 55, 2005, 74) and HBV-related liver cancer is the most common cause of premature death in West Africa (Lancet Oncol, 9, 2008, 683; Hepatology, 39, 2004, 211). As such, HBV represents a significant global threat to health in the African continent. Most SSA countries have elected to vaccinate all children against HBV through the WHO-sponsored Expanded Program of Immunization and the current recommendation from WHO-AFRO is for birth-dose HBV vaccination to prevent maternal/child transmission (MFT) and early horizontal transmission of HBV. However, in Africa, HBV vaccine coverage remains low and HBV birth-dose vaccination has not been implemented. HBV transmission from mother to child in the early perinatal period therefore remains a significant contributor to the burden of HBV-related disease in SSA. This review explores the evidence for materno-foetal transmission of HBV in SSA, outlining current practice for HBV MFT prevention and identifying the significant challenges to implementation of HBV prevention in SSA.

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