Mother-to-child transmission (MTCT) is an important route of new hepatitis B virus (HBV) infections. In Africa, limited and conflicting data on the effectiveness of hepatitis B birth dose vaccination (HepB-BD) have contributed to fragmented adoption and sub-optimal implementation. We aimed to assess the effectiveness of timely HepB-BD in preventing HBV MTCT in Ethiopia.MethodsWe conducted a multi-centre cross-sectional observational study in Ethiopia from May 2022 to June 2024. We identified mothers who had tested positive for hepatitis B surface antigen (HBsAg) during pregnancy and assessed mother-infant pairs at 6-12 months post-partum for HBV MTCT. We stratified effectiveness of HepB-BD by maternal risk profile (HBV DNA level, hepatitis B e-antigen (HBeAg) status).ResultsThe analysis included 387 children born to HBV-positive, HIV-negative mothers who had completed routine HBV vaccination (HepB3). The median age of infant testing was 10 months (IQR 7.0-11). Overall MTCT risk was 5.2% (95% CI 3.4,7.8). MTCT was significantly lower among infants receiving HepB-BD alone (0/39, 0% [95% CI 0-9.0]) compared to those without immunoprophylaxis at birth (20/131, 15.3% [95% CI 10.1-22.4]) (p = 0.009). No transmission occurred with HepB-BD plus HBIg (0/217, 0% [95% CI 0-1.7]). Maternal viral load >200,000 IU/ml (AOR 16.6, 95% CI 4.82,57.19) and HBeAg positivity (AOR 4.21, 95% CI 1.08,16.44) were associated with increased MTCT risk amongst infants without immunoprophylaxis at birth.ConclusionsIn Ethiopia, the current vaccination series starting at 6 weeks is insufficient to prevent HBV MTCT. Timely HepB-BD is highly effective in reducing HBV MTCT and should be prioritised for scale-up in Africa.

Timely hepatitis B birth dose highly effective in preventing mother-to-child transmission in Ethiopia. In Ethiopia, the current vaccination series starting at 6 weeks is insufficient to prevent HBV MTCT. Real-world / observational study, Clinical infectious diseases, 24 Sep 2026.

Elimination of hepatitis B virus (HBV) is not achievable without prevention of mother-to-child transmission (PMTCT). In its 2024 guidelines, the WHO guidelines identified major research gaps on HBV MTCT in Africa.AimsFollowing the implementation of an antenatal HBV screening in The Gambia, we estimated the rate of HBV MTCT and the peripartum care cascade among pregnant women.Methodsmulticentre, non-randomised interventional study in Gambian antenatal clinics. Following mass and individual sensitisation, consecutive pregnant women were offered HBV testing and blood collection for further retrospective HBV MTCT risk assessment. HBsAg-positive mothers and their babies were prospectively followed up to 6-9 months post-partum. The primary endpoint was the rate of HBV MTCT defined by the proportion of HBsAg-positive babies.ResultsBetween 2019 and 2022, 9,697/9,708 (99.9%) pregnant women accepted HBV screening; 449/9,697 tested positive (HBsAg prevalence:4.6% (95%CI:4.2-5.1)). Among 428 traceable live births, 216 (49.6%) babies were successfully tested for HBV; 6/216 were positive giving a 2.8% rate of MTCT (1.1-6.2). Major gaps in the HBV prevention and care services were identified: 64% of newborns did not receive HBV birth-dose vaccine, 25% of HBsAg-positive pregnant women refused to give blood for further risk stratification, and 62% were not linked to care after delivery. A small proportion (<2%) of women were eligible for postpartum treatment according to the 2017 EASL and 2024 WHO guidelines.ConclusionIn The Gambia, the residual risk of HBV MTCT exceeds the elimination absolute target. Strategies to improve the peripartum and post-partum HBV care cascade are urgently needed.

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Viral hepatitis is a significant global public health challenge. Hepatitis B Virus (HBV) is accountable for the majority of the challenges. The main transmission mode of HBV in highly endemic countries is perinatal. However, there is limited evidence on the incidence of mother-to-child transmission (MTCT) and its associated factors in Ethiopia impacting the implementation of tailored control interventions. Thus, this study aimed to estimate the incidence of MTCT of HBV and its associated factors. A prospective observational cohort study was conducted among 110 infants born to hepatitis B surface antigen (HBsAg)-positive mothers from February 2023 to February 2024 in selected public health facilities in Addis Ababa, Ethiopia. Follow-up evaluations were conducted at birth and at 9 months post-delivery. Socio-demographic and clinical characteristics of mother-infant pairs, and laboratory investigations were assessed to determine the incidence of MTCT and associated factors. Frequencies and percentages were used to summarize infant characteristics. Poisson regression model with robust standard errors was employed to identify factors associated with MTCT of HBV. The level of significance was set at P < 0.05. The mean age of the mothers was 28 ± 4.9 years. Of the 110 mothers positive for HBsAg, 10(9.1%) were positive for HBeAg and 11(10.1%)...

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