Cape Verde: Cabo Verde Sets the Bar for Ending Mother-to-Child Transmission of Viral Hepatitis

"Vaccinating is protecting who you love the most. Everyone should do it," implores Orisa Brito, a mother of three children living in Praia, the capital of Cabo Verde. Her youngest child, Lila, is a healthy 5-month-old who received a dose of hepatitis B vaccine within hours of her birth and is due for another dose in a month.

World Hepatitis Day - July 28 - draws global attention to the disease that Lila is now vaccinated against. Hepatitis is one of the world's leading causes of death. In Africa, viral hepatitis takes the lives of some 200 000 people each year, mostly from viral hepatitis B- and C-related liver disease, including cirrhosis and liver cancer.

World Health Organization (WHO) Member States are signatories to the Global Health Sector Strategy on Viral Hepatitis, which calls for the elimination of the disease by 2030 (defined as a 90% reduction in new cases and 65% reduction in deaths). WHO has developed a scorecard for Africa that will examine, for the first time ever, the regional hepatitis prevalence and response. The first results reflect that only three of the 47 WHO Member States are on track to eliminate the disease.

"This analysis is the first to track each country in the region and to assess progress towards the goal of saving the lives of more than two million Africans who may develop progressive hepatitis B or C liver disease in the next decade if countries fail to ramp up their efforts," says Dr Matshidiso Moeti, WHO Regional Director for Africa.

Mother-to-child and perinatal transmission are the most prevalent routes for spreading hepatitis B in Africa. As the scorecard indicates, Cabo Verde is one of only 11 countries in the sub-Saharan region to have instituted a WHO-endorsed birth-dose protocol that aims to break this chain of transmission.

In Cabo Verde, all pregnant women are encouraged to test for hepatitis B and to vaccinate their babies at birth, a practice instituted in 2002 that added a fourth point of protection to the regimen of three doses already in place.

In 2010, the Cabo Verde Health Ministry introduced the routine pentavalent vaccine programme, which provides protection against five common childhood threats, including hepatitis B. The vaccine is given in three doses: at two months, at four months and at six months. To date, all countries in the region follow this routine childhood vaccine protocol.

Maria Alice Ramos is an Immunization Technical Assistant at Agostinho Neto National Hospital in Praia, the health facility where Lila was born. She is in charge of delivering the first vaccines to babies, including hepatitis B, polio and tuberculosis. "In a month, I can vaccinate 300 to 400 children," she says. "I come to the hospital every day to make sure that all children are vaccinated."

All babies leave the hospital with a vaccine notebook. Their mothers then take them to the nearest health centre to continue the vaccination plan, Ramos explains, with pride.

"This is in line with WHO recommendations to provide both birth dose and infant vaccination for hepatitis B," says Evanilda Santos, National Coordinator of the Expanded Immunization and Child Health Program at the Ministry of Health and Social Security, describing the high-bar routine in Cabo Verde.

According to Ministry of Health data, vaccination coverage at birth in the country is around 99%, and coverage of the pentavalent vaccine has been more than 90% for the past decade, reaching 97.3% in 2018.

Vaccination is carried out in maternity hospitals, where 98.7% of pregnant Cabo Verdean women choose to give birth. As testament to the success of the programme, only four newborns in the country in 2018 waited longer than 24 hours to receive their vaccination.

According to Dr Carolina Leite, Disease Prevention and Control Officer for WHO in Cabo Verde, the Government mobilizes financial resources to maintain the vaccination programme and has committed to eliminating hepatitis B.

"The Cabo Verdean Government funds all vaccines. WHO is encouraged by this commitment and the firm political will to support vaccination and end the scourge of hepatitis B," she says.

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