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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: January 2018 - Volume 37 - Issue 1 - p 103–107
doi: 10.1097/INF.0000000000001728
Vaccine Reports

Background: 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.

Methods: 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.

Results: Among 4594 mothers analyzed, 66.7% (95% confidence interval [CI]: 64.1–69.3) of infants completed the hepatitis B vaccine series; however, an average 4-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; 95% CI: 1.2–3.1 comparing the highest and lowest quintiles), Christian religion (aOR: 1.8; 95% CI: 1.3–2.5 compared with Muslim religion) and older maternal age (aOR: 1.4; 95% CI: 1.2–1.7 for 10 year units).

Conclusions: 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.

Supplemental Digital Content is available in the text.

From the *Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL; Clinton Health Access Initiative, Yaounde, Cameroon; § Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia and Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Obstetrics and Gynecology, University of Buea, Buea, Cameroon; Cameroon Baptist Convention Health Services, Bamenda, Cameroon; and **Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL.

Accepted for publication July 9, 2017.

The authors have no conflicts of interest to disclosure.

J.D-.O. is supported by NIH/NICHD 1K23HD090993. MJV is supported by NIH K01TW00998 The funding source did not have a role in the development or publication of the findings.

The study was conceptualized and designed by J.D-.O., A.O.W. and A.T.N.T. A.O.W. was involved in the statistical analysis. J.D-.O. collected the data and drafted the initial article. D.N., M.J.V. and A.T.N.T. helped with data interpretation and along with G.H.E. and T.W., provided key edits to the article.

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Address for correspondence: Jodie Dionne-Odom, MD, 908 20th Street South, Room 325A, Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2050. E-mail:

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