HEPATITIS B BD

INTRODUCTION PLAN IN
GHANA

ATSU SEAKE-KWAWU,
GHANA HEALTH SERVICE/MOH
MAY 5, 2021
Ghana Background
• Population: 30,955,204 (GSS, 2020 est)
• CBR: 28.826 births per 1000
• Expected births (2020): 892,314
• Women’s health
• At least one ANC visit-97%
• At least 4 ANC visits-87%
• Deliver in health facility-73%

GSS.DHS.2014
Ghana-BCG, OPV0 and Penta3 coverage
trends
BCG, OPV0 and Penta3 coverage, 2016-2020

120

103.5
100 98.4 98.4
95.6
98.6 99.9 99.9 99.4 93
96.9

80
74.8 74.7 74.7 75.3
Coverage (%)

71.4
60

40

20 BCG OPV0 Penta 3

0
2016 2017 2018
Year 2019 2020
Estimated burden of Hepatitis B using
HBsAg prevalence
• General population- 12.3% (Ofori-Asenso and Agyeman, 2016)
• Pregnant women-Unknown (but 12% median prevalence estimated of 4 hospital-
based studies published before 2014)
• Subject of ongoing CDC-funded Seroprevalence study

• Children <5 years- 0.64% (0.50%-0.80%) Modelled data IHME, 2019

Ofori-Asenso, R. and A.A. Agyeman, Hepatitis B in Ghana: a systematic review & meta-analysis of prevalence studies (1995-2015). BMC Infect Dis, 2016. 16: p. 130.

Breakwell, L., et al., The status of hepatitis B control in the African region. Pan Afr Med J, 2017. 27(Suppl 3): p. 17.
Current Process for the HepB BD
Introduction
• Hep B-BD described as potential new vaccine in cMYP 2015-2019 for introduction in 2017
• NITAG required evidence of disease burden before introduction
• In 2020 CDC/WHO/GHS/NMIMR developed protocol to estimate the seroprevalence of
hepatitis B among pregnant women using 2019 HIV Sentinel survey samples
• Necessary approvals have been obtained for study to start
• Evidence obtained will be presented to NITAG for evaluation
• Hepatitis Programme will disseminate the results to wide stakeholder platforms to build
support and expectation for BD
• Once NITAG approves, application will be submitted by EPI to GAVI to support Government of
Ghana to introduce BD

Government of Ghana.cMYP.2014
 Hepatitis B Screening and Prevention Policy

Ghana New Maternal and Child Health

Record
Hepatitis B Screening and Prevention Policy

• Policy on preventing mother to child transmission of HBV is incorporated into

RMNCAH policy in principle
• HBsAg screening of pregnant women on-going but not reported
• Multiple rapid test kits in use of doubtful approval status
• National Programme has not yet developed Testing policy/algorithm
• Treatment guidelines for infected pregnant women are yet to be updated to reflect
current WHO recommendations
• Interventions to prevent MTCT_HBV are not yet on public offer
• Imported HBIG and Birth dose HB are available in privately in some cities
Challenges Facing The Hepatitis B Birth Dose Programme

• Most important challenge now is obtaining early data for NITAG decision
• Other foreseen challenges include
• Orienting midwives to accept birth dose vaccinator role within labour wards with all its
accompanying responsibilities
• Documentation
• Accessing EPI cold chain/ maintenance
• Reporting

• Reaching newborns born outside health facilities within 24 hours

• Early information flow
• Availability of staff to vaccinate at home
• Appropriate transport means availability at time of need
Opportunities For Hepatitis B BD Introduction

• Research TA is available from CDC and WHO for evidence generation

• A second study on Risk of Mother to Child Transmission of Hep B has been
submitted for ethical review
• Funding has been secured for both studies through CDC
• National cold chain capacity in every district
• Midwives already used to Vitamin A administration within 72 hours
• Midwives already administering ARV prophylaxis to HIV-exposed newborns
• Decentralized service delivery with nurses placed within communities (CHPS zones)
THANK YOU