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Predictors of Infant Hepatitis B Immunization in Cameroon: Data to Inform Implementation of a Hepatitis B Birth Dose

Dionne-Odom, Jodie MD; Westfall, Andrew O. MS; Nzuobontane, Divine MD, MPH; Vinikoor, Michael J. MD; Halle-Ekane, Gregory MD; Welty, Thomas MD, MPH; Tita, Alan T. N. MD, PhD
The Pediatric Infectious Disease Journal: Post Acceptance: August 02, 2017
doi: 10.1097/INF.0000000000001728
Vaccine Reports: PDF Only


Although most African countries offer hepatitis B immunization through a 3-dose vaccine series recommended at 6, 10, and 14 weeks of age, very few provide birth dose vaccination. In support of Cameroon’s national plan to implement the birth dose vaccine in 2017, we investigated predictors of infant hepatitis B virus (HBV) vaccination under the current program.


Using the 2011 Demographic Health Survey in Cameroon, we identified women with at least one living child (age 12-60 months) and information about the hepatitis B vaccine series. Vaccination rates were calculated and logistic regression modeling was used to identify factors associated with 3-dose series completion. Changes over time were assessed with linear logistic model.


Among 4594 mothers analyzed, 66.7% (95% CI 64.1-69.3) of infants completed the hepatitis B vaccine series; however, an average four week delay in series initiation was noted with median dose timing at 10, 14 and 19 weeks of age. Predictors of series completion included facility delivery (adjusted odds ratio [aOR] 2.1, 95% CI 1.7-2.6), household wealth (aOR 1.9, CI 1.2-3.1 comparing the highest and lowest quintiles), Christian religion (aOR 1.8, CI 1.3-2.5 compared to Muslim religion), and older maternal age (aOR 1.4, CI 1.2-1.7 for 10 year units).


Birth dose vaccination to reduce vertical and early childhood transmission of hepatitis B may overcome some of the obstacles to timely and complete HBV immunization in Cameroon. Increased awareness of HBV is needed among pregnant women and high risk groups about vertical transmission, the importance of facility delivery and the effectiveness of prevention beginning with monovalent HBV vaccination at birth.

The authors have no conflicts of interest with this work.

JDO is supported by NIH/NICHD 1K23HD090993. The funding source did not have a role in the development or publication of the findings.

Corresponding Author: Jodie Dionne-Odom, MD, 908 20th Street South, Room 325A, Division of Infectious Diseases, Department of Medicine,. University of Alabama at Birmingham, Birmingham, Alabama 35294-2050,, (205) 975 6530 office (205) 996 7675 fax, (603) 305 9638 cell

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