The status of hepatitis B control in the African region

The World Health Organization (WHO) African Region has approximately 100 million people with chronic hepatitis B virus (HBV) infection. This review describes the status of hepatitis B control in the Region. We present hepatitis B vaccine (HepB) coverage data and from available data in the published literature, the impact of HepB vaccination on hepatitis B surface antigen (HBsAg) prevalence, a marker of chronic infection, among children, HBsAg prevalence in pregnant women, and risk of perinatal transmission. Lastly, we describe challenges with HepB birth dose (HepB-BD) introduction reported in the Region, and propose strategies to increase coverage. In 2015, regional three dose HepB coverage was 76%, and 16(34%) of 47 countries reported ≥ 90% coverage. Overall, 11 countries introduced HepB-BD; only nine provide universal HepB-BD, and of these, five reported ≥ 80% coverage. From non-nationally representative serosurveys among children, HBsAg prevalence was lower among children born after HepB introduction compared to those born before HepB introduction. However, some studies still found HBsAg prevalence to be above 2%. From limited surveys among pregnant women, the median HBsAg prevalence varied by country, ranging from 1.9% (Madagascar) to 16.1% (Niger); hepatitis B e antigen (HBeAg) prevalence among HBsAg-positive women ranged from 3.3% (Zimbabwe) to 28.5% (Nigeria). Studies in three countries indicated that the risk of perinatal HBV transmission was associated with HBeAg expression or high HBV DNA viral load. Major challenges for timely HepB-BD administration were poor knowledge of or lack of national HepB-BD vaccination guidelines, high prevalence of home births, and unreliable vaccine supply. Overall, substantial progress has been made in the region. However, countries need to improve HepB3 coverage and some countries might need to consider introducing the HepB-BD to help achieve the regional hepatitis B control goal of < 2% HBsAg prevalence among children < 5 years old by 2020. To facilitate HepB-BD introduction and improve timely coverage, strategies are needed to reach both facility-based and home births. Strong political commitment, clear policy recommendations and staff training on HepB-BD administration are also required. Furthermore, high quality nationally representative serosurveys among children are needed to inform decision makers about progress towards the regional control goal

Rotavirus Disease Burden in Africa and the Need to Accelerate Introduction of Vaccines

It is important to establish the burden of rotavirus disease before and after the introduction of a rotavirus vaccine. Regional effortshave focused on building an unequivocal evidence base for rotavirus diarrhoea to support decisionmaking and sustained investment in new vaccine introduction. WHO recommends routine use ofrotavirus vaccines in all countries; particularlyin those with high mortality attributable todiarrhoeal disease. In countries where diarrhoeal deaths account for more than 10 of mortality inchildren aged under five years; the introduction of the vaccine is strongly recommended. This article reviews the available literature and summarizesthe estimated number of deaths in children underfive years attributable to rotavirus diarrhoea in the WHO African Region. Based on the available data; it can be concluded that the rotavirus disease burden is very high and that the introduction of rotavirus vaccines should be accelerated in the Region

Update on Elimination of Epidemic Meningitis in the African Region

At the demand of the African ministries of health; a new conjugate vaccine was developed by Serum Institute of India Limited (SIIL) against meningococcal A meningitis; the germ responsible for more than 95 of the meningitis epidemics in Africa; through a partnership between WHO and PATH and; with the financial support from the Bill et Melinda Gates Foundation. The vaccine is being introduced in all the 26 countries of the meningitis belt between 2010 and 2016. So far; 153 million people have been vaccinated in 12 countries. The vaccine is efficacious; no case of meningococcal meningitis A has been identified among vaccinated individuals and in post-campaign carriage studies. The overall number of meningitis cases dropped sharply during epidemic seasons in the countries of the belt. The vaccine will be introduced via routine immunization by the end of 2015

Surveillance for Diseases Targeted by new Vaccines: Progress; Challenges and Way Forward

Thirteen years ago; WHO-AFRO proposed the establishment of a sentinel disease surveillance network as part of efforts to improve surveillance for invasive bacterial diseases (IBD) including paediatric pneumonia and meningitis and rotavirus diarrhoea in all Member States as part of surveillance for vaccine-preventable diseases and in line with the regional strategy integrated disease surveillance and response (IDSR). This was prompted by the eminent availability of new and prospective vaccines against Haemophilus influenzae type b (Hib); Streptococcus pneumoniae (S. pneum); Neisseria meningitides (Nm) and rotavirus vaccines. The Regional Office for Africa developed guidelines and tools and standardized methodology; including cases definitions to be used to recruit eligible cases. This article outlines the challenges and results of this initiative to date and aims for the future