Factors Associated with Antibody Levels among Children Aged 15 to 59 Months Vaccinated against Hepatitis B during the Expanded Program on Immunization in Cameroon

Background: the hepatitis B virus infection remains a major public health problem worldwide. It can lead to a liver cirrhosis and/or hepatocellular carcinoma. The World Health Organisation (WHO) has recommended the implementation of generalised vaccination programs against hepatitis B. In Cameroon, this vaccine was introduced in the expanded program on immunization (EPI) in 2005, but few studies have assessed the immune response. Objective: the general objective of this study was to identify factors associated with antibody levels among children aged from 15 to 59 months vaccinated against hepatitis B during the EPI in Cameroon. Method: this was a cross-sectional study carried out from December 2021 to June 2022 in a paediatric centre of Yaoundé (Cameroon). We analysed the antibody level in children vaccinated against hepatitis B within the framework of the EPI. We enrolled children who had received a series of 3 intramuscular doses of hepatitis B vaccine at 6, 10 and 14 weeks after birth. Some children could receive a 4th booster dose between 12 months. The antibody level was assessed by measuring the anti-HBs in such children, aged 15 - 59 months. A good immunization was defined as a serum level of anti-HBs antibody level above 100 IU/mL;a poor immunization, for an anti-HBs antibody level between 10 and 100 IU/mL;and a non-immunization, for an anti-HBs antibody level < 10 IU/mL. Association between explored factors and poor or non-immunization was evaluated through the Chi square test. The significance threshold was defined at p < 0.05. Results: sixty subjects were included in the study with a slight female majority: 31 cases (52%). The average age was 38.5 ± 15.7 months (range 15 - 59 months). We found 32 (53%) cases of good immunization;21 (35%) of poor immunization;and 7 children (12%) with a non-immunization. The only factor associated with poor or non-immunization was the age between 37 - 59 months (p = 0.016). Conclusion: Anti HBs Antibody levels in children vaccinated against hepatitis B virus were globally satisfactory in our series. Results show an association between low antibody levels with older age (over 36 months), suggesting a circulating antibodies levels decrease over time, yet deemed protecting until 59 months.

Anesthetic Management of Hepatic Resection in a Low-Resource Setting: First Bulletin from Africa

Introduction: General anesthesia and antisepsis have made intraperitoneal surgery safer. With the improvement of anesthetic techniques and the development of new surgical approaches, the liver, an organ with high haemorrhagic risks, has become the subject of many successful therapeutic indications. Although widely performed in high-income settings due to a better technical platform, the reverse is true for low-resource settings in Africa where there is little or no report on the anesthetic management of this dreadful surgery. Hence, this study is one of the first from Africa to report on the perioperative anesthetic management and outcome of hepatic resections. Methods: This was a retrospective case series study conducted over four years (2019-2022) through a chart review of all medical and anesthesia records of patients admitted to Douala General Hospital, Cameroon for hepatic resection. We collected socio-demographic, clinical, laboratory and intraoperative data, the estimated financial cost and patient outcomes. Results: Twelve open hepatic resections were performed mainly electively (11/12 cases) for localized hepatic tumours (7/12 cases) on ASA II patients (11/12 cases) with a mean age of 36.5 years and sex ratio of 1.2. Pre-anesthetic consultations were usually done within 24 days before the surgery. General anesthesia maintained with sevoflurane was the mainstay anesthetic technic. Continuous hemodynamic monitoring with an arterial catheter was done. The blood-sparing strategy was based on tranexamic acid, calcium gluconate and controlled hypotension with an intraoperative transfusion rate of 33.33%. The cost of the procedures was well above the minimum wage in Cameroon but relatively cheap compared to the cost in high-income countries. No perioperative death was recorded. Conclusion: Our hepatic resections were managed with satisfactory blood savings, low morbidity and zero perioperative mortality. Overall, this study is the first to provide data on perioperative anesthetic management and outcomes of hepatic resection in Africa.