Published online Oct 8, 2015. doi: 10.4254/wjh.v7.i22.2418
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
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.
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.
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.
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.
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.
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.