How many young children worldwide still live with hepatitis B, a viral infection that attacks the liver, and is vaccination reaching babies early enough? This is what the World Health Organization (WHO) set out to answer in its World Hepatitis Day 2020 update, which looks at children under five across the globe.
This is a WHO news release with global estimates, not a trial in one country. It also cites a modelling study by Imperial College London. Modelling means a computer projection of what might happen, not a count of what did happen.
Chronic infection in under-fives fell from around 5% to just under 1%
In 2019, just under 1% of children under five were chronically infected with hepatitis B. Chronic means the infection stays in the body long term. Before vaccines (the 1980s to the early 2000s), the figure was around 5%. This met a Sustainable Development Goal target of under 1% by 2020.
Vaccination drove much of this. Worldwide coverage of three childhood doses reached 85% in 2019, up from around 30% in 2000. The vaccine gives over 95% protection against infection. Timing matters because about 90% of children infected in their first year of life become chronic carriers.
The gap: the first dose within 24 hours of birth
WHO recommends the first dose as soon as possible after birth, preferably within 24 hours, followed by at least 2 more doses. Yet global coverage of this birth dose is only 43%. It is 34% in the WHO Eastern Mediterranean Region and 6% in the WHO African Region.
WHO also recommends testing all pregnant women for hepatitis B, HIV and syphilis as early as possible. It has issued new recommendations on antiviral prophylaxis, meaning antiviral medicine for pregnant women who need it, to further reduce passing the virus to babies.
The source does not give figures for Singapore or other individual Asian countries, so we cannot say how local babies compare.
A worst-case warning from the pandemic
The Imperial College London model imagined a worst case. Birth-dose vaccination would be disrupted by 60% and childhood vaccination by 20% for one year, followed by a slow recovery. Under that scenario, there would be 5.3 million additional chronic infections among children born between 2020 and 2030, and 1 million additional hepatitis B-related deaths among them later on. This is a projection, not something that has happened.
What the findings point to for your baby
- Make sure the first hepatitis B dose is given as soon as possible after birth, preferably within 24 hours, as WHO recommends.
- Complete at least 2 further doses after the first, as WHO advises, so your child gets the full protection the vaccine offers.
- If you are pregnant, get tested for hepatitis B as early as possible, since WHO recommends testing all pregnant women.