Moonsamy Shelina, Pillay Pavitra, Singh Beverley A, Puren Adrian, Ward John W, Prabdial-Sing Nishi
Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa.
PLOS Glob Public Health. 2025 Jan 22;5(1):e0003567. doi: 10.1371/journal.pgph.0003567. eCollection 2025.
Eight years after WHO adopted a resolution to eliminate hepatitis B by the year 2030, the disease remains a global public health concern, with vertical transmission of HBV being a major obstacle to this goal. Our study aimed to determine the HBV infection status of pregnant women in South Africa at a national level to evaluate the risk of vertical transmission and provide evidence for public health decision-making. We conducted HBsAg testing on 1,942 HIV-uninfected and 2,312 HIV-infected pregnant women from South Africa's public health sector in 2017, followed by HBeAg testing on HBsAg-positive samples. Our data were stratified by five-year age groups and province. The overall HBV prevalence was 11.24% (478/4,254), significantly higher among HIV-infected women (15.83%) compared to HIV-uninfected women (5.77%, p = 0.007). HBV prevalence was highest among women 40-44 years (14.00%) and in Limpopo Province (19.35%). Coinfection rates of HIV-HBV ranged from 14.00% to 17.00% among women 15-44 years, and provincially, rates were highest in Limpopo, North West, and Western Cape Provinces (>20%). HBeAg prevalence among HBsAg positive women was 9.48%, with higher rates among HIV infected women (11.29%) compared to HIV-uninfected women (7.34%, p = 0.7931). HBeAg prevalence was highest among women 15-19 (10.81%), 20-24 (11.88%) and 40-44 years (25.00%), and provincially, highest in North West (26.67%). Our findings highlight the significant prevalence of HBV infection among pregnant women in 2017, emphasising concerns about vertical transmission, particularly given the high prevalence of HBeAg among HBsAg-positive women. We advocate for the prompt implementation of a universal birth dose of the HBV vaccine in South Africa to augment existing vaccination schedules and mitigate the risk of vertical transmission, thereby advancing progress towards WHO elimination targets.
在世界卫生组织通过到2030年消除乙型肝炎的决议八年之后，该疾病仍然是全球公共卫生问题，乙肝病毒的垂直传播是实现这一目标的主要障碍。我们的研究旨在确定南非全国范围内孕妇的乙肝病毒感染状况，以评估垂直传播风险，并为公共卫生决策提供依据。2017年，我们对来自南非公共卫生部门的1942名未感染艾滋病毒和2312名感染艾滋病毒的孕妇进行了乙肝表面抗原检测，随后对乙肝表面抗原阳性样本进行了乙肝e抗原检测。我们的数据按五岁年龄组和省份进行分层。总体乙肝病毒流行率为11.24%（478/4254），感染艾滋病毒的女性（15.83%）明显高于未感染艾滋病毒的女性（5.77%，p = 0.007）。乙肝病毒流行率在40 - 44岁女性中最高（14.00%），在林波波省最高（19.35%）。15 - 44岁女性中艾滋病毒与乙肝病毒的合并感染率在14.00%至17.00%之间，在省级层面，林波波省、西北省和西开普省的合并感染率最高（>20%）。乙肝表面抗原阳性女性中乙肝e抗原流行率为9.48%，感染艾滋病毒的女性（11.29%）高于未感染艾滋病毒的女性（7.34%，p = 0.7931）。乙肝e抗原流行率在15 - 19岁（10.81%）、20 - 24岁（11.88%）和40 - 44岁女性中最高（25.00%），在省级层面，西北省最高（26.67%）。我们的研究结果突出了2017年孕妇中乙肝病毒感染的显著流行情况，强调了对垂直传播的担忧，特别是考虑到乙肝表面抗原阳性女性中乙肝e抗原的高流行率。我们主张在南非迅速实施普遍的乙肝疫苗出生剂量接种，以加强现有的疫苗接种计划并降低垂直传播风险，从而推动朝着世界卫生组织消除目标取得进展。
