Bridging the Immunization Gap: Hepatitis B Vaccine Coverage and Uptake in HIV-exposed and Unexposed Children in South Africa
1
Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
2
Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town, South Africa
3
National Health Laboratory Service, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
4
HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
5
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
6
National Immunization Technical Advisory Group (NITAG) Support Hub, Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Limited evidence on the burden of hepatitis B virus (HBV) infection among children living with HIV (CLWH), HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children hinders progress towards eliminating hepatitis B.
METHODS:
This study used secondary data and archival sera (N= 671) from children <13 years old attending health facilities in the Western Cape, South Africa. Hepatitis B vaccine coverage was assessed using vaccination records for doses 1 to 3 by 12 months of age. Timely uptake was defined as receipt of a dose from 4 days before to 28 days after the recommended age. Serological markers of infection and immunity were measured using Elecsys® test kits (Roche Diagnostics, Germany). Logistic regression was performed to assess factors associated with incomplete and delayed vaccination.
RESULTS:
Coverage with all three doses by 12 months was 86.7% (13/15), 80.9% (263/325), and 77.0% (57/74) for CLWH, HUU, and HEU, respectively. Hepatitis B vaccine coverage decreased across all subgroups as the schedule progressed. The highest proportion of delayed uptake for the third dose was noted among CLWH at 23.1% (3/13), followed by 21.6% (58/269) among HUU and 15.3% (9/59) among HEU children (p= 0.540). Median delay for dose 3 was longest among CLWH (11.3 weeks) compared to HUU (6.7 weeks) (p=0.368). HBV infection was detected in 1.4% (1/74) of HEU and 0.3% (1/328) of HUU children, while no cases among CLWH. Factors associated with completing the third dose included crèche attendance, low-to-middle socio-economic status (SES), timely uptake of dose 1, participant’s age, and HIV exposure status. Crèche attendance was associated with a lower likelihood of delayed uptake, while increasing age was associated with a higher likelihood of delay.
CONCLUSIONS:
Our findings highlight disparities in timely hepatitis B vaccine uptake and coverage, emphasizing the need for interventions ensuring timely vaccine uptake among HIV-exposed children.
Limited evidence on the burden of hepatitis B virus (HBV) infection among children living with HIV (CLWH), HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children hinders progress towards eliminating hepatitis B.
METHODS:
This study used secondary data and archival sera (N= 671) from children <13 years old attending health facilities in the Western Cape, South Africa. Hepatitis B vaccine coverage was assessed using vaccination records for doses 1 to 3 by 12 months of age. Timely uptake was defined as receipt of a dose from 4 days before to 28 days after the recommended age. Serological markers of infection and immunity were measured using Elecsys® test kits (Roche Diagnostics, Germany). Logistic regression was performed to assess factors associated with incomplete and delayed vaccination.
RESULTS:
Coverage with all three doses by 12 months was 86.7% (13/15), 80.9% (263/325), and 77.0% (57/74) for CLWH, HUU, and HEU, respectively. Hepatitis B vaccine coverage decreased across all subgroups as the schedule progressed. The highest proportion of delayed uptake for the third dose was noted among CLWH at 23.1% (3/13), followed by 21.6% (58/269) among HUU and 15.3% (9/59) among HEU children (p= 0.540). Median delay for dose 3 was longest among CLWH (11.3 weeks) compared to HUU (6.7 weeks) (p=0.368). HBV infection was detected in 1.4% (1/74) of HEU and 0.3% (1/328) of HUU children, while no cases among CLWH. Factors associated with completing the third dose included crèche attendance, low-to-middle socio-economic status (SES), timely uptake of dose 1, participant’s age, and HIV exposure status. Crèche attendance was associated with a lower likelihood of delayed uptake, while increasing age was associated with a higher likelihood of delay.
CONCLUSIONS:
Our findings highlight disparities in timely hepatitis B vaccine uptake and coverage, emphasizing the need for interventions ensuring timely vaccine uptake among HIV-exposed children.
| eISSN: | 2654-1459 |
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