PROGRESS TOWARDS THE COMPREHENSIVE CONTROL OF HEPATITIS-B IN AFRICA -A VIEW FROM SOUTH-AFRICA

The carrier rate of hepatitis B virus (HBV) in black Africans averages 10 . 4% throughout the continent. Even within each country, however, there may be wide variations. HEV carriage in black Africans is largel y established in early childhood, mostly through horizontal transmissi on. Perinatal transmission also occurs but to a much lesser extent tha n in the Far East. For unknown reasons, HBeAg positivity rates are muc h lower in black Africans of childbearing age than in women in the Far East. Universal HBV vaccination of infants in South Africa started in April 1995. Effective integration into the Expanded Programme on Vacc ination will probably be necessary if administration of second and thi rd doses is to be ensured. Fortunately, a natural process of urbanisat ion is also having a beneficial effect on the black carrier rate in So uth Africa, as urban carrier rates tend to be much lower than those in rural area. Within the next 20 years, therefore, there should be a gr eat reduction in the numbers of acute HBV infections and new carriers. However, it will take much longer before there is any substantial imp act on the burden of the longterm sequelae of HBV infection - that is, cirrhosis and hepatocellular carcinoma.