Hepatitis B virus (HBV) remains a major global health challenge, affecting over 290 million people worldwide. Africa and Asia bear the highest burden, yet many African countries lack the infrastructure needed for effective prevention and management. Additionally, HBV receives minimal donor funding, and while some governments allocate national resources, these remain largely insufficient. As a result, liver-related complications, including liver cancer, cirrhosis, and liver failure, contribute to significant mortality across the continent.

HBV is preventable through vaccination and lifestyle modifications. In Uganda, the pentavalent vaccine was incorporated into the Expanded Program for Immunization (EPI) in 2002. A national sero-survey in 2004 reported an overall HBV prevalence of 10%, with regional disparities—Northern Uganda had rates between 18% and 25%, while Southern Uganda reported about 4%. A follow-up survey in 2016 indicated a national prevalence of 4.1%, but the North-South gradient persisted, with rates of 4.6% and 0.8% respectively.

Mother-to-child transmission (MTCT) significantly contributes to the HBV burden and is a primary cause of chronic hepatitis B. However, this transmission route is largely preventable, especially through timely birth-dose vaccination. In 2023, Uganda introduced the HBV birth-dose vaccine, ensuring that all newborns—regardless of maternal HBV or HIV status—receive the vaccine at birth, followed by pentavalent doses at 6, 10, and 14 weeks. This intervention has the potential to drastically reduce MTCT. The addition of hepatitis B immune globulin (HBIG) could further enhance prevention efforts, but its high cost and limited availability pose significant challenges. Nonetheless, birth-dose vaccination alone remains a crucial and effective strategy.

Challenges in Birth-Dose HBV Vaccination in Uganda

Despite the introduction of the birth-dose vaccine, several challenges persist:

1. Vaccine Shortages: Global supply constraints have led to stockouts in Uganda, leaving some newborns unvaccinated.
2. Home Deliveries: A significant number of births still occur outside formal health facilities, reducing vaccine access for newborns.
3. Timing of Vaccination: Even when deliveries occur in healthcare settings, weekend and public holiday births may delay administration beyond the critical 24-hour window.

Proposed Solutions

1. Targeted Vaccination and Antiviral Therapy: Strengthening antenatal HBV screening would allow healthcare providers to prioritize birth-dose vaccination for babies born to mothers living with HBV. This, combined with antiviral therapy for high-viremia mothers, could significantly reduce transmission.
2. Community-Based Interventions: Engaging village health teams to identify home deliveries and facilitate postnatal vaccination at health centers could improve vaccine coverage, even if administration falls slightly outside the ideal 24-hour window.

Conclusion

Mother-to-child transmission remains a key driver of HBV persistence in Uganda. However, with comprehensive prevention measures—including universal birth-dose vaccination, targeted maternal screening, and community outreach—Uganda can make significant strides in reducing HBV transmission and protecting future generations.