Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis.

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health Pub Date : 2025-03-01 DOI:10.1016/S2214-109X(24)00506-0

Nicholas Riches, Marc Y R Henrion, Peter MacPherson, Camilla Hahn, Rabson Kachala, Thomas Mitchell, Daniel Murray, Wongani Mzumara, Owen Nkoka, Alison J Price, Jennifer Riches, Aoife Seery, Noel Thom, Anne Loarec, Maud Lemoine, Gibril Ndow, Yusuke Shimakawa, Peyton Thompson, Camille Morgan, Shalini Desai, Philippa Easterbrook, Alexander J Stockdale

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引用次数: 0

Abstract

Background: More new infections with hepatitis B virus (HBV) occur annually in the WHO African region than in the rest of the world combined. We did a systematic review and meta-analysis to estimate the prevalence of hepatitis B surface antigen (HBsAg) in pregnant women and vertical transmission events in the region.

Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, Africa Index Medicus, and Africa Journals Online for publications between Jan 1, 1992, and Jan 7, 2024, with no language restrictions. HBsAg prevalence and vertical transmission (HBsAg positivity in children aged 6-12 months) were estimated with the use of binomial mixed models with logit links, stratified by infant vaccination status. We estimated HBsAg prevalence for subregions of Africa and for the WHO African region by weighting by estimated livebirths for each subregion. We estimated transmission events using WHO and UNICEF vaccine coverage data and UN population estimates.

Findings: We included 113 studies reporting on HBsAg prevalence from 190 983 pregnant women and 11 studies reporting on vertical transmission. HBsAg prevalence in women receiving antenatal care in the WHO African region (based on 2014-23 data) was 6·2% (95% CI 5·3-7·2). No relationship between risk of bias and HBsAg prevalence was observed. In 2022, an estimated 172 000 vertical transmission events (95% CI 82 000-383 000) occurred (0·4% of livebirths), a fall from a peak of 339 000 (149 000-634 000; 1·2% of all livebirths) in 2001. Increasing birth dose vaccination coverage to the WHO target of 90% could reduce vertical transmission by 43·7% (95% CI 11·6-78·0) to 97 000 events per year (95% CI 58 000-160 000). Adding maternal antiviral prophylaxis with 90% coverage could reduce transmission by 86·3% (95% CI 78·4-94·6) to 24 000 events per year (95% CI 14 000-39 000; 0·06% of livebirths) and achieve WHO elimination targets.

Interpretation: Vertical transmission is an important contributor to HBV transmission in the WHO African region. Scaling up of hepatitis B birth dose vaccination and antiviral prophylaxis is urgently needed, which could achieve elimination of vertical transmission.

Funding: Wellcome Trust.

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乙型肝炎病毒在世卫组织非洲区域的垂直传播：系统回顾和荟萃分析。

背景：世卫组织非洲区域每年新感染乙型肝炎病毒（HBV）的人数超过世界其他地区的总和。我们进行了系统回顾和荟萃分析，以估计该地区孕妇中乙型肝炎表面抗原（HBsAg）的患病率和垂直传播事件。方法：在这项系统评价和荟萃分析中，我们检索了PubMed、Embase、Scopus、Africa Index Medicus和Africa Journals Online，检索了1992年1月1日至2024年1月7日之间的出版物，没有语言限制。采用具有logit关联的二项混合模型，按婴儿疫苗接种状况分层，估计HBsAg患病率和垂直传播（6-12月龄儿童HBsAg阳性）。我们对非洲分区域和世卫组织非洲区域的HBsAg流行率进行了估计，方法是对每个分区域的估计活产进行加权。我们使用世卫组织和联合国儿童基金会的疫苗覆盖率数据和联合国人口估计值来估计传播事件。研究结果：我们纳入了113项报告19983名孕妇HBsAg患病率的研究和11项报告垂直传播的研究。世卫组织非洲地区接受产前保健的妇女中HBsAg患病率（基于2014-23年数据）为6.2%（95%可信区间为5.3 - 7.2）。未观察到偏倚风险与HBsAg患病率之间的关系。2022年，估计发生了17.2万起垂直传播事件（95%可信区间82000 - 383000）（占活产的0.4%），较峰值33.9万起(14.9万- 63.4万；占所有活产婴儿的1.2%)。将出生剂量疫苗接种覆盖率提高到世卫组织90%的目标，可将垂直传播减少43.7%（95%可信区间11.6 - 78.0）至每年97000例（95%可信区间5.8 - 16000）。增加覆盖率为90%的孕产妇抗病毒预防可将传播减少86.3% （95% CI为78.4 - 94.6）至每年24000例(95% CI为14000 - 39000；占活产的0.06%)，并实现世卫组织的消除目标。解释：垂直传播是世卫组织非洲区域HBV传播的一个重要因素。迫切需要扩大乙型肝炎出生剂量疫苗接种和抗病毒预防，以实现消除垂直传播。资助：惠康信托基金。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

44.10

自引率

1.20%

发文量

763

审稿时长

10 weeks

期刊介绍： The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.