HepB-BD is the first dose of the Hepatitis B vaccine given to newborns within 24 hours of birth to prevent transmission from mother to child, while HepB3 is the third dose given to children between 6 and 18 months to complete the vaccination series and ensure long-term protection.

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In 2022, an estimated 5 million people in the World Health Organization (WHO) Region of the Americas (AMR) were living with chronic hepatitis B virus (HBV) infection, a leading cause of liver cancer and cirrhosis worldwide. Vaccination with Hepatitis B (HepB) vaccine, including the birth dose (HepB-BD) and additional doses (HepB3), has been crucial in preventing mother-to-child transmission (MTCT). While HepB3 coverage is high, HepB-BD is still missing in 17 countries, and recent declines in vaccination coverage threaten progress toward eliminating MTCT.¹

By 2012, all 51 AMR countries and territories had implemented HepB3 nationwide. By 2021, 34 countries provided the HepB-BD nationwide. Mathematical models indicate that as of 2022, hepatitis B surface antigen (HBsAg) seroprevalence in children is ≤.1% in 14 countries and at the regional level. Moreover, 3 of the 51 countries met the 95% coverage targets for both HepB3 and HepB-BD in 2021 and 2022, with two likely achieving the criteria for eliminating MTCT of HBV.1

In 2022, HepB3 coverage had declined by ≥10 percentage points in 15 of 41 countries with 2012 coverage data for comparison, and HepB-BD still missing in 17 countries. These declines and gaps in HepB-BD availability threaten the Pan American Health Organization’s (PAHO) progress toward eliminating MTCT of HBV.¹

Despite the progress made in reducing perinatal HBV transmission through vaccination, global coverage of the birth dose remains at a low 45%, with even lower rates in the WHO African region. To meet PAHO’s targets, which include achieving ≥95% coverage for both HepB-BD and HepB3 and ensuring ≥80% of pregnant women receive HBsAg testing^.2

“The WHO recommends that newborns receive the HBV vaccine within 24 hours of birth, or as early as possible. This is a critical measure to prevent new infections, and it’s important to remember that this is a cancer-preventing vaccine,” explains Danjuma Adda, MPH, FIMS, Dip-IMS, past president of the World Hepatitis Alliance. “To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. The vaccines must be accessible exactly where and when the babies are born.”³

PAHO aims to reduce chronic HBV infection to ≤0.1% among children by achieving ≥95% coverage for both the HepB birth dose and additional doses, as well as ensuring ≥80% of pregnant women are tested for HBsAg.¹

This report has two main limitations. First, data on current HepB-BD and HepB3 vaccination schedules, coverage, or MTCT elimination indicators are incomplete for some countries and years, affecting the accuracy of regional progress summaries. Second, not all countries distinguish between timely and any HepB-BD administration, which may lead to an overestimation of timely birth dose coverage.¹

Despite advancements, gaps in HepB birth dose coverage and declining HepB3 rates present significant challenges. Efforts to improve vaccination coverage and availability are important to meet PAHO’s targets and eliminate MTCT of HBV.

References

1. Alleman MM, Sereno LS, Whittembury A, et al. Progress Toward Elimination of Mother-to-Child Transmission of Hepatitis B Virus — Region of the Americas, 2012–2022. MMWR Morb Mortal Wkly Rep. Published July 25, 2024. Accessed July 30, 2024. DOI: http://dx.doi.org/10.15585/mmwr.mm7329a3

2. Easterbrook P, Luhmann N, Bajis, et. al. WHO 2024 Hepatitis B Guidelines: An Opportunity to Transform Care. Lancet. Published April 10, 2024. Accessed July 30, 2024. DOI: https://doi.org/10.1016/S2468-1253(24)00089-X

3. Abene S. Hepatitis B Virus (HBV) Bridges Gap Between Policy and Implementation in Vaccine Coverage. Contagion. Published April 12, 2024. Accessed July 30, 2024. https://www.contagionlive.com/view/hepatitis-b-in-focus-bridges-the-gap-between-policy-and-implementation-in-vaccine-coverage