Hepatitis B Virus Seroprevalence in Ayacucho, Peru: A Comprehensive Review Across the Pre-Vaccination and Post-Vaccination Periods.

Abstract

Hepatitis B virus (HBV) infection remains a global public health concern, with perinatal transmission as the primary route in endemic populations. Ayacucho is a priority region due to its high incidence (second nationally between 2019 and 2024) and the significant decline in vaccination coverage (~15%). This study aims to synthesize existing epidemiological evidence on HBV seroprevalence in Ayacucho, Peru, emphasizing temporal changes observed before and after the implementation of vaccination programs to inform control strategies. This review was conducted, integrating data from diverse population groups, including children, pregnant women, blood donors, high-risk individuals (military personnel, female sex workers, prisoners), and household contacts, to identify transmission patterns and evaluate the impact of immunization efforts. Historically, Ayacucho was hyperendemic, with an HBsAg prevalence of 20% in Huanta (1985-1986) and a high mortality from liver diseases. The introduction of a vaccination in the 1990s led to a drastic reduction in infection rates among children, from 24.4-30.4% (1994) to 2.3-5.1% (1997), and improved overall Expanded Program on Immunization (EPI) coverage. However, recent data (2000-2024) reveal a concerning increase in HBV cases since 2012, with peaks in 2016 and 2023, correlating with a decline in vaccination rates post-2021. HBV prevalence remains elevated among high-risk populations-including military personnel, female sex workers, and prisoners-as well as among blood donors (HBsAg: 3.73-5.0%; anti-HBc: 21-33%). In addition, significant knowledge gaps and low adherence to EPI strategies were observed. Despite initial vaccination success, Ayacucho faces a resurgence of HBV infection, exacerbated by declining vaccine coverage and vulnerabilities in high-risk populations. Reinforcing immunization programs and screening strategies is urgent to control and eventually eliminate HBV cases in the region.