Peer-reviewed article
Closing the hepatitis B birth-dose gap in Cameroon: Global evidence and policy imperatives.
Tambe Elvis Akem ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Hepatitis B virus causes significant disease burden in Cameroon, where chronic infection affects about 11% of people born before 2005. Currently, no newborns receive the hepatitis B birth-dose vaccine in Cameroon, even though vaccinating within 24 hours of birth prevents chronic infection in 80-90% of cases. The country's vaccination policy only targets infants of known hepatitis B-positive mothers, leaving many unprotected, particularly in rural areas with home births and limited screening. The document proposes using existing BCG vaccination programs to deliver birth-dose hepatitis B vaccination to all newborns.
Key points
- Hepatitis B birth-dose coverage was 0% in Cameroon in 2024
- Infection at birth leads to chronic HBV in 80-90% of cases, with approximately one in four dying prematurely
- Post-2005 birth cohorts show much lower prevalence (0.7%) compared to pre-2005 cohorts (11.2%), indicating vaccine impact when delivered
- Infant series completion is only 68% with subnational gaps, and selective birth-dose policy restricts access to infants of known HBsAg-positive mothers
- High-coverage BCG platforms could be leveraged to close the birth-dose gap within 24 hours of birth
Limitations
The document does not present empirical results from an intervention trial in Cameroon. The hospital-based cohort from 2009-2010 is not nationally representative, so actual birth-dose impact may differ across the country's diverse populations and delivery settings.
Abstract
Hepatitis B virus infects an estimated 254 million people worldwide and caused 1.1 million deaths in 2022. In the WHO African Region, about 65 million people live with chronic HBV (HBsAg prevalence 5.8%). In Cameroon, pooled HBsAg prevalence was 11.2% among pre-2005 cohorts, born before infant HBV vaccination, versus 0.7% in a hospital-based cohort of children recruited in 2009-2010 among post-2005 births (not nationally representative). Nonetheless, HepB birth-dose coverage was 0% in 2024; infection at birth leads to chronic HBV in 80-90% of cases, with roughly one in four dying prematurely. Completion of the infant series is 68%, with subnational gaps leaving many children unprotected. Cameroon's selective policy restricts the timely birth-dose to infants of known HBsAg-positive mothers, further perpetuating inequities. In hard-to-reach areas, antenatal screening is limited and home deliveries are common; the same children who miss the infant series also miss the birth-dose. Leveraging high-coverage BCG platforms could help close this gap and protect newborns within 24 hours of birth. This commentary reviews global evidence for the birth-dose, analyzes Cameroon's policy gaps, and proposes equity-focused actions for universal birth-dose adoption, strengthened delivery systems and supply chains, and data-driven governance to reach WHO's 2030 elimination targets in Cameroon.