Original Article

Neonatal vaccination and HBV prevalence: evidence from Esfandiar village, Iran

Abstract

Background and Objectives: Hepatitis B virus (HBV) remains a major public health challenge, particularly in hyperendemic regions. This study assessed the effectiveness of Iran's national HBV vaccination program in Esfandiar village, South Khorasan Province, where HBV prevalence substantially exceeds the national average. We compared hepatitis B surface antigen (HBsAg) prevalence between cohorts born before and after implementation of the universal vaccination program in 1993.
Materials and Methods: We conducted a cross-sectional seroprevalence study encompassing both unvaccinated individuals (born before 1993) and vaccinated individuals (born 1993 onwards) in Esfandiar village. Serum samples were analyzed for HBsAg, hepatitis B e antigen (HBeAg), and hepatitis B core antibody (HBcAb) using enzyme-linked immunosorbent assay (ELISA).
Results: HBsAg prevalence was markedly higher among unvaccinated individuals (22.56%, 132/585) compared to vaccinated individuals (1.19%, 3/252), yielding a vaccine effectiveness of 94.74%. Among vaccinated children, 54% maintained protective antibody titers (>10 mIU/mL), with highest levels observed in children born to HBsAg-positive mothers. Conversely, 46% of vaccinated children demonstrated suboptimal antibody titers (<10 mIU/mL), predominantly among those born to HBsAg-negative mothers. Notably, all three HBsAg-positive vaccinated children were born to mothers with concurrent HBsAg and HBeAg positivity.
Conclusion: The national HBV vaccination program demonstrates remarkable effectiveness in reducing HBsAg prevalence, underscoring the critical importance of universal neonatal immunization in endemic settings. Enhanced preventive strategies, including hepatitis B immunoglobulin (HBIG) administration to infants of HBeAg-positive mothers, could further optimize protection. Sustained surveillance and rigorous adherence to vaccination protocols remain essential for achieving comprehensive HBV control.

1. Trépo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet 2014; 384: 2053-2063.
2. Elizalde MM, Tadey L, Mammana L, Quarleri JF, Campos RH, Flichman DM. Biological characterization of Hepatitis B virus Genotypes: Their role in viral Replication and antigen Expression. Front Microbiol 2021; 12: 758613.
3. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol 2012; 10: 452-459.
4. Kidd-Ljunggren K, Holmberg A, Blackberg J, Lindqvist B. High levels of hepatitis B virus DNA in body fluids from chronic carriers. J Hosp Infect 2006; 64: 352-357.
5. Zhang C, Liu Y, Zhao H, Wang G. Global Patterns and trends in total Burden of Hepatitis B from 1990 to 2019 and Predictions to 2030. Clin Epidemiol 2022; 14: 1519-1533.
6. Ward J, Robinson PJ. How to detect hepatocellular carcinoma in cirrhosis. Eur Radiol 2002; 12: 2258-2272.
7. Aspinall EJ, Hawkins G, Fraser A, Hutchinson SJ, Goldberg D. Hepatitis B prevention, diagnosis, treatment and care: a review. Occup Med (Lond) 2011; 61: 531-540.
8. Suk-Fong Lok A. Hepatitis B Treatment: What We Know Now and What Remains to Be Researched. Hepatol Commun 2018; 3: 8-19.
9. Meireles LC, Marinho RT, Van Damme P. Three decades of hepatitis B control with vaccination. World J Hepatol 2015; 7: 2127-2132.
10. Matthews PC, Ocama P, Wang S, El-Sayed M, Turkova A, Ford D, et al. Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus. JHEP Rep 2023; 5: 100777.
11. Behzadifar M, Azari S, Shirkhani S, Gholamrezaei S, Shahabi S, Doshmangir L, et al. Hepatitis B vaccination in Iran: Historical policies and programs. J Prev Med Hyg 2022; 63: E618-E624.
12. Moghadami M, Dadashpour N, Mokhtari AM, Ebrahimi M, Mirahmadizadeh A. The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: a historical cohort study. Braz J Infect Dis 2019; 23: 419-426.
13. Javanmard D, Alavian SM, Abedi F, Namaei MH, Asghari A, Ziaee M. High prevalence of hepatitis B virus infection in the Village of Esfandiar in South Khorasan Province, Iran. Hepatol Mon 2018; 18(8): e65473.
14. Leong J, Lin D, Nguyen MH. Hepatitis B surface antigen escape mutations: Indications for initiation of antiviral therapy revisited. World J Clin Cases 2016; 4: 71-75.
15. Li S, Xie M, Li W, Peng Q, Zhong B, Lu X, et al. Prevalence of S gene mutations within the major hydrophilic region of hepatitis B virus in patients in Dongguan, southern China. Arch Virol 2017; 162: 2949-2957.
16. Hashemi SA, Moghadami M, Lankarani KB, Alborzi A, Mahboudi A. The efficacy of hepatitis B vaccination among school age children in Southern Iran. Iran Red Crescent Med J 2010; 12: 45-48.
17. Rezaei M, Nooripoor S, Ghorbani R, Ramezanshams F, Mamishi S, Mahmoudi S. Seroprotection after hepatitis B vaccination in children aged 1 to 15 years in central province of Iran, Semnan. J Prev Med Hyg 2014; 55: 1-3.
18. Najafi F, Sayehmiri K, Najafi R. Efficacy of hepatitis B vaccination in under five-year-old children in Iran: A systematic review and meta-analysis study. Hepat Mon 2018;18(6): e65385.
Files
IssueVol 17 No 5 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v17i5.19893
Keywords
Hepatitis B Immunization programs Infant Seroepidemiologic studies Vaccine efficacy

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Jarrahi N, Khosrojerdi A, Osmani F, Ziaee A, Ziaee M. Neonatal vaccination and HBV prevalence: evidence from Esfandiar village, Iran. Iran J Microbiol. 2025;17(5):841-847.