The proportion of children under five years old chronically infected with hepatitis B dropped to just under 1% in 2019, down from around 5% in the pre-vaccine era between the 1980s and early 2000s, according to new estimates from the World Health Organization.
This drop marks the achievement of a milestone target set by the Sustainable Development Goals to reach under 1% prevalence of the hepatitis B virus in children under five by 2020. Globally, more than 250 million people live with chronic hepatitis B infections, and the virus claims the lives of nearly 900,000 people each year.
“No infant should grow up only to die of hepatitis B because they were not vaccinated — today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations,” said Dr Tedros Adhanom Ghebreyesus, pointing out that preventing mother-to-child transmission is the most important strategy for controlling the disease.
Infants are especially vulnerable to the virus because about 90% of children infected in their first year of life become chronic carriers. To counter this, the World Health Organization recommends that all infants receive a first dose of the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.
Global Hepatitis B Vaccine Coverage Shows Regional Disparities
The scale-up of the hepatitis B vaccine worldwide over the last two decades has been driven largely by support from Gavi, the Vaccine Alliance. In 2019, coverage of three doses of the vaccine during childhood reached 85% worldwide, a substantial rise from around 30% in 2000.
However, access to the first critical dose within 24 hours of birth remains uneven across different regions of the world. Global coverage of this birth dose is 43%, but that figure is 34% in the WHO Eastern Mediterranean Region and 6% in the WHO African Region.
“Expanding access to a timely birth dose of the hepatitis B vaccine is the cornerstone of efforts to prevent mother-to-children transmission of HBV,” said Dr Meg Doherty, emphasizing that sub-Saharan Africa must prioritize assuring protection as early as possible.
Infants Need Hepatitis B Vaccines Within 24 Hours of Birth
- Birth Dose Timing: Infants need their first hepatitis B vaccine within 24 hours of birth to block vertical transmission—meaning spread from mother to child during childbirth—before the virus can establish a chronic infection.
- Antiviral Prophylaxis: Pregnant women with high viral loads receive preventive antiviral therapy to dramatically lower the concentration of the virus in their blood, protecting the newborn before birth.
- Triple Elimination: Stopping mother-to-child transmission of hepatitis B aligns with global initiatives targeting HIV, syphilis, and hepatitis B simultaneously in low- and middle-income countries.
Antiviral Interventions During Pregnancy
In addition to infant immunizations, protecting children involves providing pregnant women with antiviral treatment to reduce mother-to-child transmission. The World Health Organization recommends routine testing for hepatitis B alongside HIV and syphilis as early as possible in pregnancy.
Under new guidance issued on Monday, pregnant women who test positive and show high levels of the hepatitis B virus in their blood should receive preventive antiviral therapy using tenofovir from the 28th week of pregnancy until birth. Tenofovir is available at low cost in many countries for less than US$3 per month.
In settings where viral load testing is unavailable, the World Health Organization recommends using an alternative low-cost test known as HBeAg to determine whether a woman qualifies for the preventive antiviral therapy. Stopping vertical transmission forms a key pillar of the global triple elimination initiative.
| Indicator | Historical Baseline | Current Estimates (2019) |
|---|---|---|
| Childhood HBV Prevalence (<5 years) | Around 5% (1980s–early 2000s) | Just under 1% |
| 3-Dose Childhood Vaccine Coverage | Around 30% (2000) | 85% worldwide |
| Global Birth Dose Coverage | Not specified | 43% worldwide |
Pandemic Disruption Threats to Children
The COVID-19 pandemic threatens to slow progress in eliminating hepatitis B worldwide. A new modelling study conducted by Imperial College London in collaboration with the World Health Organization warns that pandemic-related disruptions could severely impact future targets.
Under a worst-case scenario featuring high disruption levels of 60% for the birth dose and 20% for childhood immunizations over one year, alongside delayed recovery efforts, projections point to 5.3 million additional chronic infections among children born between 2020 and 2030.
This disruption could also lead to 1 million additional hepatitis B-related deaths among those children later in life. “Even in the midst of the COVID-19 pandemic, we must ensure that mothers and newborns have access to life-saving services including hepatitis B vaccinations,” Ghebreyesus said.
World Hepatitis Day is commemorated each year on July 28 to enhance awareness of viral hepatitis. The theme for 2020 is a hepatitis-free future, maintaining a strong focus on protecting mothers and newborns.
