When will South Africa take the prevention of chronic HBV infection seriously?
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i2.3771Keywords:
South Africa, HBV birth-doseAbstract
South Africa (SA) bears a significant burden of hepatitis B virus (HBV) infection, with a significant prevalence of hepatitis B surface antigen (HBsAg) among pregnant women. In response, the National Department of Health has recommended targeted birth-dose vaccination for infants born to HBsAg-positive mothers. While we commend the move towards antenatal HBsAg screening to identify infected pregnant women, we reiterate that a universal HBV birth-dose vaccination strategy would be a simpler, more equitable and more effective approach to preventing vertical transmission and reducing the overall HBV burden in SA.
References
1. CDA Foundation. Hepatitis B – South Africa. CDA Foundation, 2025. https://cdafound.org/polaris/
dashboard/ (accessed 12 March 2025).
2. Dlamini NR, Maja P. The Expanded Programme on Immunisation in South Africa: A story yet to be
told. S Afr Med J 2016;106(7):675-677. https://doi.org/10.7196/SAMJ.2016.v106i7.10956
3. Ayoola EA, ed. Viral Hepatitis in Africa in the 90s: Facing Realities. Tokyo: Springer Japan, 1994.
4. Kew MC. Progress towards the comprehensive control of hepatitis B in Africa: A view from South
Africa. Gut 1996;38 Suppl 2(Suppl 2):S31-36. https://doi.org/10.1136/gut.38.suppl_2.s31
5. Andersson MI, Maponga TG, Ijaz S, et al. The epidemiology of hepatitis B virus infection in
HIV-infected and HIV-uninfected pregnant women in the Western Cape, South Africa. Vaccine
2013;31(47):5579-5584. https://doi.org/10.1016/j.vaccine.2013.08.028
6. World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people
with chronic hepatitis B infection (text extract): Executive summary. Infect Dis Immun 2024;4(3):103-
105. https://doi.org/10.1097/ID9.0000000000000128
7. National Department of Health, South Africa. National Guidelines for the Management of Viral Hepatitis.
Pretoria: NDoH, 2019. https://knowledgehub.health.gov.za/system/files/elibdownloads/2020-08/SA%20
NDOH_Viral%20Hepatitis%20guidelines%20final.pdf (accessed 10 March 2025).
8. National Department of Health, South Africa. Hepatitis B vaccine – targeted birth dose 2023.
Pretoria: NDoH, 2023. https://knowledgehub.health.gov.za/system/files/2023-11/KH%20webinar%20
Session%202%20Hep%20B%20vaccine%20-%20final.pdf. (accessed 10 May 2025).
9. Moonsamy S, Pillay P, Singh BA, Puren A, Ward JW, Prabdial-Sing N. Hepatitis B infection (HBsAg and
HBeAg) status among women attending antenatal care at public healthcare facilities of South Africa,
2017. PLOS Glob Pub Health 2025;5(1):e0003567. https://doi.org/10.1371/journal.pgph.0003567
10. Davey HD, Hsiao NY, Spearman WC, et al. Low prevalence of hepatitis B virus infection in HIVuninfected
pregnant women in Cape Town, South Africa: Implications for oral pre-exposure
prophylaxis roll out. BMC Infect Dis 2022;22(1):719. https://doi.org/10.1186/s12879-022-07697-5
11. Diale Q, Pattinson R, Chokoe R, Masenyetse L, Mayaphi S. Antenatal screening for hepatitis B virus
in HIV-infected and uninfected pregnant women in the Tshwane district of South Africa. S Afr Med J
2015;106(1):97-100. https://doi.org/10.7196/SAMJ.2016.v106i1.9932
12. King J, Hagemeister DT. Hepatitis B co-infection in HIV-infected patients receiving antiretroviral
therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape. South Afr J HIV
Med 2016;17(1):336. https://doi.org/10.4102/sajhivmed.v17i1.336
13. Bhattacharya D, Guo R, Tseng CH, et al. Hepatitis B virus clinical and virologic characteristics in
an HIV perinatal transmission study in sub-Saharan Africa. AIDS 2024;38(3):329-337. https://doi.
org/10.1097/QAD.0000000000003752
14. Chotun N, Preiser W, van Rensburg CJ, et al. Point-of-care screening for hepatitis B virus infection in
pregnant women at an antenatal clinic: A South African experience. PLoS ONE 2017;12(7):e0181267.
https://doi.org/10.1371/journal.pone.0181267
15. Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral
load. N Engl J Med 2016;374(24):2324-2334. https://doi.org/10.1056/NEJMoa1508660
16. Funk AL, Lu Y, Yoshida K, et al. Efficacy and safety of antiviral prophylaxis during pregnancy to
prevent mother-to-child transmission of hepatitis B virus: A systematic review and meta-analysis.
Lancet Infect Dis 2021;21(1):70-84. https://doi.org/10.1016/S1473-3099(20)30586-7
17. Woldesenbet S, Cheyip M, Lombard C, et al. Progress towards the UNAIDS 95-95-95 targets among
pregnant women in South Africa: Results from the 2017 and 2019 national Antenatal HIV Sentinel
Surveys. PLoS ONE 2022;17(7):e0271564. https://doi.org/10.1371/journal.pone.0271564
18. Woldesenbet SA, Kufa T, Lombard C, et al. The 2017 National Antenatal Sentinel HIV Survey, South
Africa. Pretoria: National Department of Health, 2019.
19. Chien LN, Vargas-Zambrano JC, Ku MY. Decreasing hepatitis B seroprevalence in pregnant women
in Taiwan between 2016 and 2021: A claim-based cohort study. BMC Public Health 2025;25(1):111.
https://doi.org/10.1186/s12889-025-21308-3
20. Akokuwebe ME, Idemudia ES. Factors associated with choice of home birth as place of delivery among
women of reproductive age in South Africa. Afr J Reproduct Health 2023;27(1):22-40. https://doi.
org/10.29063/ajrh2023/v27i1.3
21. Ndwandwe D, Nnaji CA, Mashunye T, Uthman OA, Wiysonge CS. Incomplete vaccination and
associated factors among children aged 12 - 23 months in South Africa: An analysis of the South
African Demographic and Health Survey 2016. Hum Vaccin Immunother 2021;17(1):247-254. https://
doi.org/10.1080/21645515.2020.1791509
22. Gavi The Vaccine Alliance. Hepatitis B birth dose investment case. Gavi, 2018. https://www.gavi.org/
sites/default/files/document/ppc-meeting-18-19-october-2018---vis-06a---annex-c--hepatitis-bbirth-
dose-investment-casepdf.pdf (accessed 18 October 2025).
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