MMWR, Volume 70, Issue 30 — July 30, 2021
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Morbidity and Mortality Weekly Report Weekly / Vol. 70 / No. 30 July 30, 2021 Progress Toward Hepatitis B Control — World Health Organization European Region, 2016–2019 Nino Khetsuriani, MD, PhD1; Liudmila Mosina, MD2; Pierre Van Damme, MD, PhD3; Antons Mozalevskis, MD4; Siddhartha Datta, MD2; Rania A. Tohme, MD1 In 2019, an estimated 14 million persons in the World Health newborns. In addition, 35 (73%) of the 48 countries with uni- Organization (WHO) European Region* (EUR) were chroni- versal infant HepB vaccination reached ≥90% HepB3 coverage cally infected with hepatitis B virus (HBV), and approximately annually during 2017–2019, and 19 (83%) of the 23 countries 43,000 of these persons died from complications of chronic HBV with universal birth dose administration achieved ≥90% timely infection (1). In 2016, the WHO Regional Office for Europe set HepB-BD coverage¶ annually during that period. Antenatal hepatitis B control program targets for 2020, including 1) ≥90% hepatitis B screening coverage was ≥90% in 17 (57%) of coverage with 3 doses of hepatitis B vaccine (HepB3), 2) ≥90% 30 countries that selectively provided HepB-BD to infants born coverage with interventions to prevent mother-to-child trans- to mothers with positive HBsAg test results. In January 2020, mission (MTCT) of HBV,† and 3) ≤0.5% prevalence of HBV Italy and the Netherlands became the first counties in EUR to surface antigen (HBsAg)§ in age groups eligible for vaccination be validated to have achieved the regional hepatitis B control with hepatitis B vaccine (HepB) (2–4). This report describes targets. Countries can accelerate progress toward hepatitis B the progress made toward hepatitis B control in EUR during control by improving coverage with HepB and interventions to 2016–2019. By December 2019, 50 (94%) of 53 countries in EUR provided routine vaccination with HepB to all infants or ¶ A timely HepB birth dose is defined as a dose administered within 24 hours of birth. children aged 1–12 years (universal HepB), including 23 (43%) countries that offered hepatitis B birth dose (HepB-BD) to all INSIDE * EUR is one of six WHO regions and consists of the following 53 member states (total population, approximately 932 million): Albania, Andorra, 1036 Disparities in COVID-19 Vaccination Coverage Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Among Health Care Personnel Working in Long- Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Term Care Facilities, by Job Category, National Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Moldova, Monaco, Healthcare Safety Network — United States, Montenegro, Netherlands, North Macedonia, Norway, Poland, Portugal, March 2021 Romania, Russia, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine, United Kingdom, 1040 SARS-CoV-2 Infection in Public School District and Uzbekistan. Employees Following a District-Wide Vaccination † In EUR, interventions to prevent MTCT of HBV include either Program — Philadelphia County, Pennsylvania, 1) administering a timely birth dose of HepB vaccine to all newborns (universal March 21–April 23, 2021 birth dose policy) or 2) conducting routine antenatal screening of pregnant women for hepatitis B and vaccinating infants born to HBV-infected mothers 1044 Guidance for Implementing COVID-19 Prevention with HepB birth dose within 24 hours of birth (selective birth dose policy), Strategies in the Context of Varying Community either of which is followed by ≥2 additional vaccine doses according to the Transmission Levels and Vaccination Coverage national immunization schedule. In addition, some countries provide antiviral treatment to pregnant women with positive HBsAg test results and administer 1048 QuickStats hepatitis B immune globulin at birth to infants of infected mothers. § Before introduction of vaccination, the HBV endemicity in EUR, defined by HBsAg antigen seroprevalence, ranged widely from low (<2.0%) in Continuing Education examination available at 25 countries, to intermediate (2.0%–7.9%) in 25 countries, to high (≥8.0%) https://www.cdc.gov/mmwr/mmwr_continuingEducation.html in three countries. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report prevent MTCT and documenting achievement of the HBsAg with positive HBsAg test results. During 2016–2019, regional seroprevalence target through representative serosurveys or, in HepB3 coverage increased from 82% to 92%, partly because low-endemicity countries, antenatal screening. three more countries (Norway, Switzerland, and the United Kingdom)¶¶ introduced universal infant HepB vaccination Immunization Activities during 2017–2018. Among the countries that provided uni- As a major intervention to prevent perinatal and childhood versal infant HepB vaccination, those that reported ≥90% hepatitis B infections, WHO recommends that all infants HepB3 coverage among infants increased from 37 (82%) of receive ≥3 doses of HepB, including a timely birth dose (5). 45 countries during 2016–2017 to 41 (85%) of 48 countries Most countries in EUR introduced HepB vaccination >15 years in 2019. However, HepB3 coverage was <90% for ≥3 years ago (Table 1). Countries report information on immuniza- during 2016–2019 in six countries.*** Of the 21 countries tion schedules and coverage annually to WHO and UNICEF with universal HepB-BD that reported birth dose coverage to using the WHO/UNICEF Joint Reporting Form. WHO and WHO,††† coverage with timely HepB-BD during 2016–2019 UNICEF review administrative coverage data and surveys to was ≥90% in 2019–2020 (90%–95%). generate country-specific coverage estimates.** In 2019, 48 (91%) of the 53 countries in EUR provided Antenatal Screening and Postexposure universal routine infant HepB vaccination, two†† (4%) Prophylaxis (Hungary and Slovenia) provided universal routine HepB The 30 countries that implement a selective HepB-BD policy vaccination to children aged 5–12 years, and three countries aim to prevent MTCT of HBV infection through antenatal (6%) (Denmark, Finland, and Iceland) implemented selective HBV screening combined with postexposure prophylaxis of HepB vaccination, only immunizing those born to moth- infants born to mothers with positive HBsAg test results. ers with positive HBsAg test results.§§ Twenty-three (43%) Information on implementation of these interventions is not countries provided HepB-BD to all newborns, and 30 (57%) routinely reported to WHO. Based on the responses to a sur- provided HepB-BD selectively to children born to mothers vey conducted by the WHO Regional Office for Europe in ** https://immunizationdata.who.int/listing.html?topic = coverage&location = eur ¶¶ Norway and the United Kingdom in 2017, and Switzerland in 2018. †† In Hungary, HepB is given at age 12 years, and in Slovenia, it is given at age 5–6 years. *** Austria, Bosnia and Herzegovina, Germany, Montenegro, San Marino, and §§ All countries are in northern Europe and have historically had very low Ukraine. HBV endemicity. ††† Bosnia and Herzegovina and Russia do not report HepB-BD coverage. The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2021;70:[inclusive page numbers]. Centers for Disease Control and Prevention Rochelle P. Walensky, MD, MPH, Director Debra Houry, MD, MPH, Acting Principal Deputy Director Daniel B. Jernigan, MD, MPH, Acting Deputy Director for Public Health Science and Surveillance Rebecca Bunnell, PhD, MEd, Director, Office of Science Jennifer Layden, MD, PhD, Deputy Director, Office of Science Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Charlotte K. Kent, PhD, MPH, Editor in Chief Martha F. Boyd, Lead Visual Information Specialist Ian Branam, MA, Ginger Redmon, MA, Jacqueline Gindler, MD, Editor Alexander J. Gottardy, Maureen A. Leahy, Co-Acting Lead Health Communication Specialists Brian A. King, PhD, MPH, Guest Science Editor Julia C. Martinroe, Stephen R. Spriggs, Tong Yang, Shelton Bartley, MPH, Paul Z. Siegel, MD, MPH, Associate Editor Visual Information Specialists Lowery Johnson, Amanda Ray, Mary Dott, MD, MPH, Online Editor Quang M. Doan, MBA, Phyllis H. King, Jacqueline N. Sanchez, MS, Terisa F. Rutledge, Managing Editor Terraye M. Starr, Moua Yang, Health Communication Specialists Teresa M. Hood, MS, Lead Technical Writer-Editor Information Technology Specialists Will Yang, MA, Leigh Berdon, Glenn Damon, Soumya Dunworth, PhD, Visual Information Specialist Srila Sen, MA, Stacy Simon, MA, Jeffrey D. Sokolow, MA, Technical Writer-Editors MMWR Editorial Board Timothy F. Jones, MD, Chairman Matthew L. Boulton, MD, MPH William E. Halperin, MD, DrPH, MPH Carlos Roig, MS, MA Carolyn Brooks, ScD, MA Jewel Mullen, MD, MPH, MPA William Schaffner, MD Jay C. Butler, MD Jeff Niederdeppe, PhD Nathaniel Smith, MD, MPH Virginia A. Caine, MD Celeste Philip, MD, MPH Morgan Bobb Swanson, BS Jonathan E. Fielding, MD, MPH, MBA Patricia Quinlisk, MD, MPH Abbigail Tumpey, MPH David W. Fleming, MD Patrick L. Remington, MD, MPH 1030 MMWR / July