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October 05, 2021, 21:03

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A Reader Comment We read with interest the review article by Amponsah-Dacosta E, with title”Hepatitis B virus infection and hepatocellular carcinoma in sub-Saharan Africa: Implications for elimination of viral hepatitis by 2030? It was published in World J Gastroenterol 2736:6025-6038, online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6025 The review article addressed the high mortality-to-incidence ratio associated with HCC in sub-Saharan Africa suggests significant inequities in access to appropriate health care. It also evaluates the evidence on the extent of the disease burden in the region and advocates for prioritizing HCC control as part of ongoing viral hepatitis elimination strategies within this region preventing new HBV infections, screening and treating existing chronic hepatitis B cases, as well as detecting and appropriately managing HCC. Descriptive as well as informative table and figures were included. However, certain issues have to be raised for discussion: • According to WHO six regions, some countries in African continent are not included in WHO African region, which contains only 47 states; however the author in Figure 3& 4 refers to the whole continent rather than WHO regions (http://www.WHO.int). • Regarding epidemiological trends in HBV-associated HCC in sub-Saharan Africa, the author addressed only the burden of human immunodeficiency virus (HIV) co-infection, with nothing concerning HBV-HCV coinfection or HBV–hepatitis D virus (HDV) co-infection[1,2] • The prevention of neonatal and early childhood infection is crucial to prevent the development of chronic HBV infection with its subsequent adverse effects. As emphasized by the author, in most sub-Saharan African countries, the first dose of the HBV vaccine is administered at 6 weeks of age, reflecting the inadequate HBV vaccination program, where, of the 111 countries which report having introduced a HBV birth dose as part of national routine immunization programs, only 11 (Algeria, Botswana, Cabo Verde, Côte d'Ivoire, The Gambia, Mauritania, Namibia, Nigeria, Sao Tome and Principe, Senegal, and Zambia) are in sub-Saharan Africa [3]. In 2009, the WHO recommended the use of the HBV birth-dose vaccine in all countries [4]. (Global target 50% by 2020 and 90% by 2030), with a consequent reduction of HBV among children to 1.3% [5]. In 2020, the WHO published new guidelines for prevention of mother to child transmission of HBV mandating universal birth dose vaccination of infants [6]. A key strategy for prevention of neonatal and early childhood infection with HBV is neonatal and infant birth dose. WHO World hepatitis Day2020 [3] confirmed that all newborns should be vaccinated against HBV at birth, followed by at least 2 additional doses and all pregnant women should be tested for HBV and receive treatment whenever needed [3].This is better to be adequately emphasized. • In order to satisfy the reader the mechanism underlying HCV-associated hepatocarcinogenesis[7, 8] is better to be addressed in the area of predominance of HBV-associated hepatocarcinogenesis in sub-Saharan Africa as both viruses are accused to development of HCC. References: 1- C Wendy Spearman, Mary Afihene, Reidwaan Ally, Betty Apica, Yaw Awuku, Lina Cunha, Geoffrey Dusheiko, Neliswa Gogela, Chris Kassianides, Michael Kew, Philip Lam, Olufunmilayo Lesi, Marie-Jeanne Lohouès-Kouacou, Papa Saliou Mbaye, Emmanuel Musabeyezu, Betty Musau, Olusegun Ojo, John Rwegasha, Barbara Scholz, Abate B Shewaye, Christian Tzeuton, Mark W Sonderup.Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets.The Lancet Gastroenterology & Hepatolog(2017); 2, (12) 900-909,ISSN 2468-1253,https://doi.org/10.1016/S2468-1253(17)30295- 2- Philippa C. Matthews, Anna Maria Geretti, Philip J.R. Goulder, Paul Klenerman, Epidemiology and impact of HIV coinfection with Hepatitis B and Hepatitis C viruses in Sub-Saharan Africa,Journal of Clinical Virology(2014); 61, (1): 20-33, ISSN 1386-6532,https://doi.org/10.1016/j.jcv.2014.05.018. 3- World Health Organization. World Health Organization/UNICEF joint reporting process. Geneva: World Health Organization/UNICEF, 2020. 4-WHO Hepatitis B vaccines: WHO position paper? Weekly Epidemiological Record. 2009; 84: 405-420 5- WHO Global hepatitis report, 2017.World Health Organization, Geneva; April, 2017.www.who.int/hepatitis/publications/global-hepatitis-report2017/en/ (accessed September 24, 2018). 6-Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b 7- Mitchell JK, McGivern DR. Mechanisms of hepatocarcinogenesis in chronic hepatitis C [published correction appears in Hepat Oncol. 2014 Oct;1(4):448]. Hepat Oncol. 2014;1(3):293-307. doi:10.2217/hep.14.7 PMCID: PMC6095168 8- Khatun M, Ray RB. Mechanisms Underlying Hepatitis C Virus-Associated Hepatic Fibrosis. Cells. 2019;8(10):1249. Published 2019 Oct 14. doi:10.3390/cells8101249 PMCID: PMC6829586 Zeinab Nabil Ahmed Said Professor of Medical Microbiology & Immunology Former Vice Dean for Education & Students’ Affairs Faculty of Medicine (For Girls) Al-Azhar University, Cairo-Egypt WJG Editorial Board Member

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