Hepatitis B Surface Antigen Seroprevalence among Prevaccine and Vaccine Era Children in Bangladesh

• Published in: The American journal of tropical medicine and hygiene Vol. 99; no. 3; pp. 764 - 771
• Main Authors: Paul, Repon C, Rahman, Mahmudur, Wiesen, Eric, Patel, Minal, Banik, Kajal C, Sharif, Ahmad R, Sultana, Sharmin, Rahman, Mizanur, Liyanage, Jayantha, Abeysinghe, Nihal, Kamili, Saleem, Murphy, Trudy, Luby, Stephen P, Mast, Eric E
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01.01.2018; The American Society of Tropical Medicine and Hygiene
• Subjects: Adult; Antigens; Bangladesh - epidemiology; Child; Child, Preschool; Children & youth; Female; Hepatitis; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B Surface Antigens - blood; Hepatitis B Vaccines - administration & dosage; Hepatitis B Vaccines - immunology; Humans; Infections; Infectious Disease Transmission, Vertical; Male; Mothers; Point-of-Care Systems; Sensitivity and Specificity; Seroepidemiologic Studies; Serologic Tests; Vaccines; Bangladesh
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.17-0721

Bangladesh introduced hepatitis B vaccine in a phased manner during 2003-2005 into the routine childhood vaccination schedule. This study was designed to evaluate the impact of the introduction of hepatitis B vaccine in Bangladesh by comparing hepatitis B surface antigen (HBsAg) prevalence among children born before and after vaccine introduction and to estimate the risk of vertical transmission of chronic hepatitis B virus (HBV) infection from mother to infant. We also evaluated the field sensitivity and specificity of an HBsAg point-of-care test strip. We selected a nationally representative sample of 2,100 prevaccine era and 2,100 vaccine era children. We collected a 5-mL blood sample from each child. One drop of blood was used to perform rapid HBsAg testing. If a child had a positive HBsAg test result with the rapid test, a blood sample was collected from the mother of the HBsAg-positive child and from the mothers of two subsequently enrolled HBsAg-negative children. All samples were tested for serologic markers of HBV infection using standard enzyme-linked immunosorbent assay. One (0.05%) child in the vaccine era group and 27 (1.2%; 95% confidence interval [CI]: 0.8-1.7%) children in the prevaccine era group were HBsAg positive. Mothers of HBsAg-positive children were more likely to be HBsAg positive than mothers of HBsAg-negative children (odds ratios = 4.7; 95% CI: 1.0-21.7%). Sensitivity of the HBsAg rapid test was 91.2% (95% CI: 76.6-98.1%) and specificity was 100% (95% CI: 99.9-100%). The study results suggest that even without a birth dose, the hepatitis B vaccine program in Bangladesh was highly effective in preventing chronic HBV infection among children.