Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 8, 2015; 7(22): 2418-2426
Published online Oct 8, 2015. doi: 10.4254/wjh.v7.i22.2418
Effectiveness of hepatitis B virus vaccination program in Egypt: Multicenter national project
Iman I Salama, Samia M Sami, Zeinab Nabil Ahmed Said, Manal H El-Sayed, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Hanaa M Emam, Safaa M Elserougy, Amal I Hassanain, Naglaa F Abd Alhalim, Fatma A Shaaban, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally
Iman I Salama, Lobna A El Etreby, Thanaa M Rabah, Dalia M Elmosalami, Amany T Abdel Hamid, Somaia I Salama, Aida M Abdel Mohsen, Samia A Hemeda, Nihad A Ibrahim, Ammal M Metwally, Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
Samia M Sami, Amal I Hassanain, Fatma A Shaaban, Child Health Department, National Research Center, Cairo 12311, Egypt
Zeinab Nabil Ahmed Said, Naglaa F Abd Alhalim, Micro-biology and Immunology Department, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11754, Egypt
Manal H El-Sayed, Pediatrics Department, Faculty of Medicine, Ain-Shams University, Cairo 11566, Egypt
Hanaa M Emam, Dermatology and Venereology Department, National Research Center, Cairo 12311, Egypt
Safaa M Elserougy, Environmental and Occupational Medicine Department, National Research Center, Cairo 12311, Egypt
Author contributions: All the authors contributed to this work.
Institutional review board statement: The study was reviewed and approved by the ethical committees of Ministry of Health (MOH), National Research Center and Ministry of Education- Egypt in accordance with the Helsinki Declaration.
Informed consent statement: All the legal guardians of the study participants were provided informed written consent prior to study enrollment. In addition, children aged above 10 years were enrolled after getting their verbal assent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Statistical code and dataset are available from the first author at salamaiman@yahoo.com. Consent for data sharing was not obtained from participants but the presented data are anonymized and risk of identification is nil. No additional data are available.
Corresponding author: Zeinab Nabil Ahmed Said, Professor in Microbiology and Immunology Department, Faculty of Medicine (for girls), Al-Azhar University, Yousef Abbas Str, Nasr City, Cairo 11754, Egypt. znabil58@yahoo.com
Received: April 26, 2015
Peer-review started: April 28, 2015
First decision: June 3, 2015
Revised: August 4, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: October 8, 2015
Processing time: 159 Days and 15.7 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatitis B virus (HBV) is considered moderately endemic in Egypt with 4% of the population having evidence of chronic HBV infection. World Health Organization recommended in 1992 to implement universal childhood vaccination worldwide. The complete vaccination series induces protective antibody levels in more than 95% of infants, children and young adults. A key goal of HBV immunization program is to reduce the prevalence of hepatitis B surface antigen (HBsAg) among cohorts born since program implementation.

Research frontiers

Although several studies have been done in Egypt to measure the effectiveness of HBV vaccination, yet these studies were done on a relatively small scale and in certain areas of Egypt from which arose the need for a large national study including numerous areas to be representative and give a clear picture of the situation in Egypt.

Innovations and breakthroughs

There have been no sero-surveys among children born since the introduction of the vaccine in Egypt. However, the finding of acute disease transmission in these cohorts indicates ongoing HBV transmission, thus the need for more in-depth evaluation of the immunization program. The present study had the greatest sample size (n = 3600) and aimed to assess the prevalence of breakthrough HBV infection (positive anti-HBc) as well as chronic carrier state (positive HBsAg) among the previously vaccinated studied children as a practical means to determine the long term protection provided by hepatitis B vaccine. It also aimed to determine health disparities and risk factors associated with non-seroprotective levels among Egyptian children aged from 9 mo to 16 years.

Applications

Successful implementation of universal vaccination policies in Egypt with a good coverage rate, together with the general improvement in infection control measures especially for high risk infants and safe blood donation can minimize the hepatitis B disease burden.

Terminology

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called HBV, can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death; Sero-protection: Following a standard hepatitis B vaccination course, antibody to HBsAg is established in the bloodstream, the antibody is known as antibodies to hepatitis B surface (anti-HBs). About 90%-99% of healthy neonates, children, adolescents and adults develop protective levels of anti-HBs; Breakthrough infection: (Positive anti-HBc): HBV infection in previously vaccinated subjects. Vaccinated subjects with anti-HBs antibody titers below the protective level are still susceptible to HBV infection, especially if they are exposed to a high viral load; HBV infections positive HBsAg: Chronic carrier state among previously vaccinated individual.

Peer-review

The manuscript is well written and is based in a large and well selected cohort that represents the Egypt young population. The conclusions and statements are well made in face of the obtained results. HBV vaccine is worldwide used and other studies have demonstrated its effectiveness in other populations. This study was focused in Egypt population and evaluated the behavior of anti-HBV response build after HBV vaccination. The expected result “The Egyptian compulsory HBV vaccination program has produced adequate protection” was correctly placed and support by the data collect.