Progress Toward Hepatitis B Control and Elimination of Mother-to-Child Transmission of Hepatitis B Virus - World Health Organization African Region, 2016-2021

MMWR Morb Mortal Wkly Rep. 2023 Jul 21;72(29):782-787. doi: 10.15585/mmwr.mm7229a2.


Chronic hepatitis B virus (HBV) infection is one of the leading causes of cirrhosis and liver cancer. In 2019, approximately 1.5 million persons newly acquired chronic HBV infection; among these, 990,000 (66%) were in the World Health Organization (WHO) African Region (AFR). Most chronic HBV infections are acquired through mother-to-child transmission (MTCT) or during early childhood, and approximately two thirds of these infections occur in AFR. In 2016, the World Health Assembly endorsed the goal of elimination of mother-to-child transmission (EMTCT) of HBV, documented by ≥90% coverage with both a timely hepatitis B vaccine (HepB) birth dose (HepB-BD) and 3 infant doses of HepB (HepB3), and ≤0.1% hepatitis B surface antigen (HBsAg) seroprevalence among children aged ≤5 years. In 2016, the WHO African Regional Committee endorsed targets for a 30% reduction in incidence (≤2% HBsAg seroprevalence in children aged ≤5 years) and ≥90% HepB3 coverage by 2020. By 2021, all 47 countries in the region provided HepB3 to infants beginning at age 6 weeks, and 14 countries (30%) provided HepB-BD. By December 2021, 16 (34%) countries achieved ≥90% HepB3 coverage, and only two (4%) achieved ≥90% timely HepB-BD coverage. Eight countries (17%) conducted nationwide serosurveys among children born after the introduction of HepB to assess HBsAg seroprevalence: six countries had achieved ≤2% seroprevalence, but none had achieved ≤0.1% seroprevalence among children. The development of immunization recovery plans following the COVID-19 pandemic provides an opportunity to accelerate progress toward hepatitis B control and EMTCT, including introducing HepB-BD and increasing coverage with timely HepB-BD and HepB3 vaccination. Representative HBsAg serosurveys among children and a regional verification body for EMTCT of HBV will be needed to monitor progress.

MeSH terms

  • COVID-19* / epidemiology
  • Child, Preschool
  • Female
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Hepatitis B virus
  • Hepatitis B* / epidemiology
  • Hepatitis B* / prevention & control
  • Hepatitis B, Chronic* / epidemiology
  • Hepatitis B, Chronic* / prevention & control
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical / prevention & control
  • Pandemics
  • Seroepidemiologic Studies
  • World Health Organization


  • gamma-hydroxy-gamma-ethyl-gamma-phenylbutyramide
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines