Hepatitis B Prevention in Iraq: Addressing Vertical Transmission and Vaccination Completion Challenges

Abstract

The viral infection caused by hepatitis B (HBV) is still a major public health issue in the Eastern Mediterranean Region. The objective of this research was to evaluate the extent of HBV vaccination coverage, recognize the factors preventing vaccination, and ascertain the rates of prevalence among different risk groups in Iraq. The cross-sectional research was conducted with a national vaccination and screening data from the healthcare centres in Al-Najaf city. Vaccination data of high-risk individuals such as health care workers (HCWs), contacts of diagnosed patients, and those belonging to occupational risk groups were re-evaluated. The HBV screening outcomes were analyzed based on 15 different risk categories (n=103,550). The structured questionnaires given to the healthcare providers were used to obtain information on the barriers to vaccination. Among the total of 103,550 individuals screened, the prevalence of HBV was 0.095% (98 positive cases). Surgical patients accounted for the highest number of cases (24.5% of positives), blood donors (22.4%) and pre-marital screening (12.2%) being the next in line. The positivity rate was 100% for the infants born to infected mothers, while it was 3.57% for the contacts of diagnosed patients. The vaccination statistics suggested that completing the dose was a very difficult task as 624 first doses were administered but only 335 were third doses completed. The percentage of vaccinated health care workers was 73.4% of all doses.The unavailability of vaccines (50%), doubts about the vaccine's safety (45%), and lack of training (40%) were identified as the main reasons for the low uptake of the vaccine. Healthcare workers' non-compliance was attributed to the beliefs about the vaccine being ineffective (37%), the perception of low disease prevalence (35%), and safety concerns (30%). This study points out the significant weaknesses in Iraq's HBV prevention program, especially vertical transmission prevention and incomplete vaccination series.