Seroprevalence of Hepatitis B and C Virus Infections among Pregnant Women in Haiti, 2012

Background:

While hepatitis B vaccine was introduced in Haiti as part of a combined pentavalent vaccine in 2012, a birth dose, which is highly effective in preventing mother to child transmission (MTCT) of infection, is not yet included in the immunization schedule. Data on the burden hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Haiti are limited and outdated. We determined the seroprevalence of HBV and HCV infections among pregnant women to estimate the risk of MTCT, and build the evidence for a hepatitis B vaccine birth dose introduction.

Methods:

We selected all 164 human immunodeficiency virus (HIV)-positive and 1200 randomly selected HIV-negative serum specimens from 6241 pregnant women attending 18 antenatal care clinics during a 2012 HIV sentinel serosurvey.  All specimens were tested for markers of HBV (total antibody to HBV core antigen (total anti-HBc), hepatitis B surface antigen (HBsAg), and HBV DNA) and HCV (antibodies to HCV (anti-HCV), HCV RNA) infection. Haiti was stratified into two regions: West region, which includes the West department with Port-au-Prince, and non-West region, which includes the remaining nine departments. We evaluated demographic and socioeconomic factors associated with HBV infection.

Results:

Of 1364 selected specimens, 1307 (96%) were available for testing. Overall 422 specimens (32.7%) tested positive for total anti-HBc (38.2% in West vs. 27% in non-West, p<0.001), and 33 specimens (2.5%) were HBsAg positive (2.1% in West vs. 3% in non-West). Of HBsAg positive specimens, 26 (79%) had detectable HBV DNA, and 15 (46%) had HBV DNA levels ≥ 5000 IU/mL. Women aged 30 and older had more than double the odds of positive total anti-HBc than women aged 15–19 years (P<0.001). Women with secondary (adjusted odds ratio (aOR) =0.54; 95%CI: 0.36–0.81) and post-secondary education (aOR=0.40, 95%CI: 0.19–0.79) had lower odds of total anti-HBc positivity compared to women with no education. HIV-status was not associated with HBV infection. Only six of 1307 (0.5%) women tested positive for anti-HCV but none was HCV RNA positive.

Conclusion:

Haiti has an intermediate endemicity of HBV infection with high prevalence of positive HBV DNA among infected pregnant women. Introduction of a universal birth dose of hepatitis B vaccine would help prevent MTCT of HBV. HCV infection does not seem to be a large burden among pregnant women in Haiti.