Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a major cause of chronic HBV infection, which can lead to cirrhosis and liver cancer. (1) Globally, an estimated 6.4 (range, 4.4-10.8) million children aged [less than or equal to] 5 years are living with chronic HBV infection. (2) In 2016, the World Health Assembly endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, including elimination of MTCT of HBV. (3) Elimination of MTCT of HBV can be validated by demonstrating [less than or equal to] 0.1% prevalence of HBV surface antigen (HBsAg) among children aged [less than or equal to] 5 years and [greater than or equal to] 90% coverage with a hepatitis B birth dose (HepB-BD) and 3 doses of hepatitis B vaccine (HepB3). (4,5) This report describes global progress towards elimination of MTCT of HBV during 2016-2021. By December 2020, 190 (98%) of the 194 WHO Member States (6) had introduced universal infant vaccination with hepatitis B vaccine (HepB), and 110 (57%) countries provided HepB-BD to all newborns. Between 2016 and 2020, global coverage with HepB3 remained between 82% and 85%, whereas HepB-BD coverage increased from 37% to 43%. In 2020, of the 99 countries that reported both HepB3 and HepB-BD coverage, 41 (41%) had achieved [greater than or equal to] 90% coverage. By December 2021, sero-surveys documented [less than or equal to] 0.1% HBsAg prevalence among children in 11 countries. Accelerating HepB-BD introduction, increasing HepB3 coverage and monitoring programmatic and impact indicators are essential for elimination of MTCT of HBV.
As immunization is a key intervention for preventing MTCT of HBV, WHO recommends that all newborns receive a timely HepB-BD, (7) followed by 2 or 3 additional HepB doses, according to national schedules. (1) Countries report immunization data to WHO annually through the WHO and UNICEF Joint Reporting Form, and WHO and UNICEF review the reported data and surveys to estimate country-specific coverage. (8)
By 2020, 190 (98%) of 194 countries had introduced universal infant hepatitis B vaccination, as compared with 186 (96%) in 2016. In 2020, 110 (57%) countries provided HepB-BD to all newborns, (9) a 10% increase from 100 (52%) in 2016. During 2016-2020, 33 to 34 (17%-18%) countries, most of which are in the European Region, administered HepB-BD selectively to newborns of HBsAg-positive mothers. (10) The number of countries that have not introduced routine HepB-BD vaccination decreased by 15% between 2016 and 2020, from 60 (31%) to 51 (26%) (11) (Table 1). Most of those countries are in the African Region, where 34 (72%) of 47 countries do not provide a HepB-BD.
Between 2016 and 2020, global coverage with HepB3 remained at 82-85%, whereas timely coverage with HepB-BD increased from 37% to 43%. During this period, regional coverage with HepB3 and HepB-BD was highest in the Western Pacific Region and lowest in the African Region (Table 1). During 2016-2019, HepB3 coverage was [greater than or equal to] 90% in 61-63% of reporting countries, and HepB-BD coverage was...