PLOS ONE
RESEARCH ARTICLE
Immunosurveillance and molecular detection
of hepatitis B virus infection amongst
vaccinated children in the West Gonja District
in Savanna Region of Ghana
Theophilus Quaye1☯, Patrick Williams Narkwa 1☯ID *, Seth A. Domfeh 2,3‡ID ,
Gloria Kattah 1,4‡ID , Mohamed Mutocheluh
1☯
1 Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of
Science and Technology, Kumasi, Ghana, 2 Department of Biochemistry, Cell and Molecular Biology, School
a1111111111
of Biological Sciences University of Ghana, Legon, Accra, Ghana, 3 West African Centre for Cell Biology of
a1111111111 Infectious Pathogens, University of Ghana, Legon, Accra, Ghana, 4 Department of Medical Laboratory
a1111111111 Technology, Radford University College, Accra, Ghana
a1111111111
a1111111111 ☯ These authors contributed equally to this work.
‡ These authors also contributed equally to this work
* pnarkwa.chs@knust.edu.gh, patricknarkwa1@gmail.com
OPEN ACCESS Abstract
Citation: Quaye T, Narkwa PW, Domfeh SA, Kattah
Hepatitis B vaccination is the most effective preventive measure in reducing the incidence of
G, Mutocheluh M (2021) Immunosurveillance and
molecular detection of hepatitis B virus infection chronic hepatitis B virus (HBV) infection and its consequences such as cirrhosis, hepatocellu-
amongst vaccinated children in the West Gonja lar carcinoma, liver failure and death. Ghana introduced the universal HBV vaccination in the
District in Savanna Region of Ghana. PLoS ONE
national Expanded Programme on Immunization in 2002. The current study sought to deter-
16(9): e0257103. https://doi.org/10.1371/journal.
pone.0257103 mine the sero-protection rate and the prevalence of HBV infection among fully vaccinated
children in the West Gonja District in the Savanna Region of Ghana. This cross-sectional
Editor: Isabelle Chemin, Centre de Recherche en
Cancerologie de Lyon, FRANCE study recruited three hundred and fifty (350) fully vaccinated children who visited West Gonja
Catholic Hospital from September to December 2019 for healthcare. Structured question-
Received: April 12, 2021
naires were administered to obtain information on the demographics. The clinical history of
Accepted: August 23, 2021
the participants was obtained from the hospital records. Sera were separated from 2-5ml of
Published: September 17, 2021 blood sample collected from each participant after informed consent had been sought from
Peer Review History: PLOS recognizes the their parents/guardians. Sera were tested for HBsAg, anti-HBs and anti-HBc using ELISA.
benefits of transparency in the peer review Samples positive for HBsAg or anti-HBc were tested for HBV DNA by Real-Time Polymerase
process; therefore, we enable the publication of
Chain Reaction. The overall sero-protection rate (anti-HBs titers� 10 mIU/mL) among the
all of the content of peer review and author
responses alongside final, published articles. The studied participants was 56% with anti-HBs geometric mean titer (GMT) of 95.7 mIU/mL (±
editorial history of this article is available here: 6.0; 95% CI) compared with GMT of 2.8 mIU/mL (± 0.2; 95% CI) among non-seroprotected
https://doi.org/10.1371/journal.pone.0257103 participants. There was no statistically significant difference in sero-protection rate between
Copyright: © 2021 Quaye et al. This is an open males and females (p-value = 0.93) and in relation to age (p-value = 0.20). The prevalence of
access article distributed under the terms of the HBV infection among studied participants as determined by the HBV DNA/HBsAg positivity
Creative Commons Attribution License, which
was 1.4% while anti-HBc sero-positivity was 2%. Even though the sero-protection rate and
permits unrestricted use, distribution, and
reproduction in any medium, provided the original HBV infection rate reported in the current study compares with that of other international stud-
author and source are credited. ies further studies need to be conducted to understand the factors related to sero-protection
Data Availability Statement: The data are available and HBV infection rate in the Savanna Region of Ghana.
in the Kwame Nkrumah University of Science and
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PLOS ONE Hepatitis B vaccination and hepatitis B virus infections
Technology (KNUST) space repository: http://ir.
knust.edu.gh/handle/123456789/14537. Introduction
Funding: The authors received no specific funding Even though hepatitis B virus (HBV) infection is a vaccine-preventable disease, the burden of
for this work. chronic HBV infection in the world is still high especially in the sub-Saharan African Region
Competing interests: The authors declare that they [1]. It is estimated that approximately 257 million people worldwide are chronically infected
have no competing interests. with HBV with about 88% of them residing in sub-Saharan Africa (SSA) [2]. Chronic HBV
infection has been identified as one of the significant risk factors in developing cirrhosis and
hepatocellular carcinoma (HCC) [3]. In Ghana, the prevalence of chronic HBV infection has
been estimated to be greater than 8% [4]. The best and the most effective way of preventing the
perinatal and horizontal spread of HBV infection is through active vaccination. In view of that,
World Health Organization (WHO) in 1992 recommended that all countries across the globe
incorporate HBV vaccination into their national childhood immunization programme and by
2014, 184 countries had adopted this measure [5]. Ghana introduced hepatitis B vaccination as
part of her Expanded Programme on Immunization (EPI) in 2002 [6]. Upon completion of
the full doses of the vaccination series, the vaccine is expected to induce protective antibody
levels in more than 95% of the recipients [7]. However, unreliable power supply in certain
parts of sub-Sahara Africa including Ghana may affect the storage condition of the vaccine
and hence its potency and efficacy. Administration of ineffective or impotent vaccine can lead
to vaccination failure. Vaccination failure can predispose vaccinees to HBV infection and
increase the transmission rate within the population. In view of this, it is appropriate that post-
vaccination surveillance is carried out to assess the effectiveness of HBV vaccination pro-
gramme in Ghana. Most studies in relation to HBV infection in Ghana have been focused
largely on the prevalence of HBV among the unvaccinated component of the population. Even
the limited studies that have been done on the vaccinated group since the commencement of
the EPI in Ghana in 2002 have largely been conducted in the southern and the middle belt of
the country and that data from Savanna Region of Ghana where West Gonja District is located
is lacking hence the current study. It is anticipated that the outcome of the current study in the
West Gonja District in the Savanna Region of Ghana would provide data or information that
would help in assessing the effectiveness of hepatitis B vaccination programme in the District.
This data would help policy makers in instituting measures that would detect early vaccination
failures so that appropriate action could be taken to prevent spread of HBV infection in the
district and Ghana as a whole.
Materials and methods
Study design and study site
This was a cross-sectional study conducted at the West Gonja Catholic Hospital, Damongo in
the Savanna Region of Ghana from September to December 2019.
Damongo is the capital of the West Gonja District in the Savanna Region of Northern
Ghana. The West Gonja District is located to the west of the Northern Regional capital Tamale.
It lies within longitude 10 51 and 20 581 West and latitude 80 321 and 100 21North. The West
Gonja District shares boundaries to the south with Central Gonja District, Bole and Sawla-
Tuna-Kalba Districts to the west, Wa East District to the north-west and North Gonja District
to the east. The District has a total land area of 4715.9sqkm, part of which is occupied by the
Mole National Park and Kenikeni Forest Reserves [8]. According to the 2010 Population and
Housing Census, the population of West Gonja District is estimated at 41,180 which consti-
tutes 1.7% of the total population in the Savanna Region. Generally, temperatures in the West
Gonja District are high. The maximum temperatures are mostly recorded during the dry sea-
son between March and April while lowest temperatures are recorded between December and
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PLOS ONE Hepatitis B vaccination and hepatitis B virus infections
January. The mean monthly temperature is 27˚C. The dry season is characterized by the Har-
mattan winds which are dry, dusty and cold in the morning and very hot at noon. During the
Harmattan periods, the humidity of the West Gonja District becomes very low and this results
in dry skin and cracked lips in humans. The area experiences bimodal rainfall pattern with
annual rainfall being estimated at 1,144 mm. The rains begin in April and ends in late October.
The peak of rainfall is in June and July with prolonged period in August [8].
Study population and eligibility criteria
The study population comprised children aged 9 months to 17 years who had received the
three doses of the pentavalent hepatitis B vaccine (DPT+HepB+ Hib) at ages 6, 10 and 14
weeks after birth as part of the EPI programme who visited the West Gonja Catholic Hospi-
tal, Damongo with their parents or legal guardians for healthcare. Children who had a com-
plete record of vaccination duly endorsed in the vaccination cards were recruited into the
study. The exclusion criteria included the following: (a) children who did not have proper
vaccination records endorsed in their vaccination cards (b) children with interval between
the last dose of hepatitis B vaccine and sampling less than one month and (c) children suf-
fering from acute illness at the time of sampling. Using a prevalence (0.7%) of HBV infec-
tion among vaccinated Ghanaian children aged 5–32 months [9], a sample size of 350 was
estimated at 95% confidence interval. Before their enrollment, written informed consent
was obtained from the parents or legal guardians of the participants. Additionally, verbal
assent was obtained from participants who were above 10 years. HBV vaccination of the
participants was confirmed by taking a full detailed vaccination history from parents or
legal guardians as well as examining the infant vaccination cards available with their
parents. Fully vaccinated participants who declined or whose parents/legal guardians
declined to partake in the study were excluded.
Ethical consideration
The study protocol was reviewed and approved by the Committee on Human Research, Publi-
cations and Ethics (CHRPE) of School of Medicine and Dentistry (SMD), Kwame Nkrumah
University of Science and Technology (KNUST), Kumasi-Ghana (reference number CHRPE/
AP/555/19). Permission was sought from the management of the West Gonja Catholic Hospi-
tal, Damongo. Informed consent was sought from each parent or legal guardian of each partic-
ipant after the purpose of the study had been explained to them in a language that they
understood.
Data and blood sample collection
A total of three hundred and fifty (350) participants were recruited into the study. Structured
questionnaires were administered to obtain demographic information of the participants. The
clinical history of the participants was obtained from hospital records. Two to five milliliters
(2–5 ml) of whole blood samples were collected from each participant by veni-puncture into
pre-labelled BD Vacutainer with SST II Advance serum-separator gel (BD, United Kingdom).
The samples were allowed to clot for 10–15 minutes and then centrifuged at 3500 rpm for 5
minutes to separate the sera. The sera were aliquoted into two (2) freshly labelled Eppendorf
tubes and temporarily stored at -20˚C at the laboratory of the West Gonja Catholic Hospital
before being transported to the Virus Research Laboratory at the Department of Clinical
Microbiology, School of Medicine and Dentistry at Kwame Nkrumah University of Science
and Technology where the samples were stored frozen at -20˚C until testing.
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Laboratory analysis
Serum samples were tested for HBsAg, anti-HBs and anti-HBc. Qualitative testing of HBsAg,
anti-HBc and quantitative testing of anti-HBs was performed using enzyme-linked immuno-
sorbent assay (ELISA) (Fortress Diagnostics, UK) following the instructions of the manufac-
turer. For the ELISA test, the samples were initially tested in singles. Samples that were initially
reactive were retested in duplicates using the same ELISA test kits. Repeatedly reactive samples
were considered positive for HBsAg, anti-HBs and anti-HBc. The sensitivity and specificity of
the test kits were greater than 99.0% as indicated by the manufacturer. Serum samples positive
for HBsAg or anti-HBc were quantitatively tested for HBV DNA by Real-Time Polymerase
Chain Reaction (RT-PCR) using a fully automated system at Komfo Anokye Teaching Hospi-
tal (KATH) in Kumasi in the Ashanti Region of Ghana. A fully automated HBV DNA extrac-
tion and RT-PCR amplification were done using COBAS1 AmpliPrep Instrument (Roche
Diagnostics, USA) and Cobas AmpliPrep/Cobas TaqMan (CAP/CTM) HBV test kits, v2.0 fol-
lowing the instructions of the manufacturer. A known HBV DNA positive sample was used as
positive control while nuclease free water was used as negative control. The positive and nega-
tive controls were included in each run. The diagnostic sensitivity of the test kit was� 95%
while the diagnostic specificity was 100% with a confidence limit of 99.54% as indicated by the
manufacturer of the test kit. The thermal cycling conditions were set according to the guide-
lines of the manufacturer.
Data analysis
Data generated were analyzed using GraphPad Prism version 8 software and IBM Statistical
Package for Social Sciences version 20 software (IBM SPSS version 20). Because of the skewed
distribution of data, anti-HBs geometric mean titer (GMT) was calculated to estimate the cen-
trality of the anti-HBs level. Anti-HBs titer value of 0.05 mIU/mL was assigned to participants
who had undetectable anti-HBs titer [10]. Categorical variables were expressed as frequencies
and percentages. Unpaired students t-test was used to compare two (2) means while one-way
analysis of variance (ANOVA) was used to compare more than two means. p-value�0.05 was
considered statistically significant. Participants with anti-HBs titers� 1mIU/mL were consid-
ered to have sero-converted and vice visa as per kit manufacturer’s instructions and WHO
standard. Participants with anti-HBs titers� 10 mIU/mL were considered to be sero-protected
against HBV infection.
Results
Sero-protection status of study participants in relation to demographic and
clinical history
A total of 490 children who visited the West Gonja Catholic Hospital with their parents or
legal guardians for healthcare during the study period were screened for eligibility out of
which 26.5% (130/490) did not meet the inclusion requirements and were excluded from the
study while 73.5% (360/490) met the inclusion requirements. Of the 130 children who did not
meet the inclusion requirements, 57.7% (75/130) had never been vaccinated against HBV
infection while 42.3% (55/130) had missing vaccination records. Of the 360 children who met
the inclusion criteria, 27.8% (10/360) declined to partake in the study and were excluded. In all
350 children comprising 49.1% (172/350) males and 50.9% (178/350) females were recruited
into the study. The mean age of the participants was 6.8 years (± 4.32 at 95% CI). Of the 350
participants tested for anti-HBs titer levels, sero-protection (anti-HBs titer� 10mIU/mL) was
detected among 56% (196/350) with geometric mean titer (GMT) of 95.7 mIU/mL (± 6.0; 95%
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PLOS ONE Hepatitis B vaccination and hepatitis B virus infections
CI) compared to mean anti-HBs titer of 2.8 mIU/mL (± 0.2; 95% CI) among non-seropro-
tected participants (anti-HBs titer< 10mIU/mL). Of the 196 participants who were sero-pro-
tected, 52.0% (102/196) were males with GMT of 94.6 mIU/mL (± 8.2; 95% CI) while 48.0%
(94/196) were females with GMT of 95.6 (± 8.7; 95% CI). There was no statistically significant
difference in the sero-protection rate between males and females (p-value = 0.93). Majority
(55.1%; 108/196) of the sero-protected participants were aged� 5years with a GMT of 100.2
mIU/mL (± 7.6; 95% CI). However, there was no statistically significant difference in sero-pro-
tection levels among the different age groups (p-value = 0.20) Table 1.
Sero-protection status of study participants in relation to clinical history
There was no statistically significant difference in sero-protection rate between participants
with a history of hospital admission, open abscess, surgical operation, blood transfusion and
participants with no such history (p-value = 0.29) Table 2.
Molecular detection of HBV infection among the fully vaccinated
participants
The prevalence of HBV infection as determined by HBsAg/HBV DNA positivity was 1.4% (5/
350) while anti-HBc positivity was 2.0% (7/350). Of the 5 participants who tested positive for
HBV DNA and HBsAg, 60.0% (3/5) were males while 40.0% (2/5) were females. In addition,
60.0% (3/5) of the participants who tested positive for HBV DNA and HBsAg were within the
age group of 11–15 years. The majority of the participants who tested positive for anti-HBc
were males (57.1%; 4/7) and within the age group of 11–15 years (57.1%; 4/7). Of the 7 partici-
pants who tested positive for anti-HBc, 71.4% (5/7) were positive for HBsAg and HBV DNA.
The two (2) participants who were anti-HBc positive but HBsAg negative [anti-HBc (+ve)/
HBsAg (-ve)] did not have detectable HBV DNA. All the five (5) participants who tested posi-
tive for HBsAg and the seven (7) participants who tested positive for anti-HBc had anti-HBs
titer of< 10mIU/mL Table 3.
Discussion
Reduction in transmission and the global burden of HBV is an achievable public health goal
owing to the availability of commercially effective and safe hepatitis B vaccines. WHO in 1992
recommended that all countries incorporate the universal hepatitis B vaccination into their
national childhood immunization programmes and by 2014, 184 countries had adopted this
Table 1. Association of demographics and sero-protection level.
Variables Anti-HBs (mIU/mL)
< 10 mIU/mL � 10 mIU/mL
n (%) GMT (mIU/mL) (95% CI) p-value n (%) GMT (mIU/mL) (95% CI) p-value
Age (yrs.)
� 5 39 (25.3) 3.5 (± 0.46) 0.11 108 (55.1) 100.2 (± 7.6) 0.20
6–10 52 (33.8) 2.9 (± 0.42) 60 (30.6) 99.5 (± 12.4)
11–15 60 (39.0 2.1 (± 0.34) 25 (12.8) 61.8 (± 11.8)
> 15 3 (1.9) 5.0 (± 2.65) 3 (1.5) 135.7 (± 69.1)
Gender
Males 70 (45.5) 2.8 (± 0.34) 1.00 102 (52.0) 94.6 (± 8.2) 0.93
Females 84 (54.5) 2.8 (± 0.32) 94 (48.0) 95.6 (± 8.7)
Total 154 (44.0) 2.8 (± 0.20) 196 (56.0) 95.7 (± 6.0)
https://doi.org/10.1371/journal.pone.0257103.t001
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Table 2. Association of participants’ clinical history and sero-protection level n (%) (p-value = 0.29).
Risk factors n (%) Levels of anti-HBs p-value Odds ratio (95% CI)
< 10 mIU/mL n (%) � 10 mIU/mL n (%)
Hospital admission
Yes 219 (62.8) 100 (45.7) 119 (54.3) 0.50 1.2 (0.8–1.8)
No 131 (37.2) 55 (42.0) 76 (58.0)
Open abscess
Yes 16 (4.6) 2 (12.5) 14 (87.5) 0.12 0.2 (0.0–0.8)
No 334 (95.4) 153 (44.1) 181 (54.2)
Surgical operation
Yes 3 (0.9) 2 (66.7) 1 (33.3) 0.44 2.5 (0.2–28.2)
No 347 (99.1) 153 (44.1) 194 (55.9)
Blood transfusion
Yes 8 (2.3) 1 (12.5) 7 (87.5) 0.10 0.2 (0.0–1.4)
No 342 (97.7) 154 (45.0) 188 (55.0)
https://doi.org/10.1371/journal.pone.0257103.t002
measure [5]. Ghana introduced hepatitis B vaccination as part of her Expanded Programme
on Immunization (EPI) in 2002 [6]. The vaccine is administered to new borns who receive
three doses of hepatitis B vaccine at age 6, 10 and 14 weeks after birth and all the participants
recruited into the study received the same dose of the pentavalent vaccine with the same paedi-
atric vaccination schedule at infancy. After completing the primary vaccination series, the
immune system of the recipients induces protective antibody levels in more than 95% of the
recipients and the protection may last for at least 20 years and possibly for life [7]. The current
study sought to determine the prevalence of HBV infection among fully vaccinated children in
the West Gonja District in the Savana Region of Ghana. The overall sero-protection rate
among the studied participants was 56%. This is comparable to the sero-protection rate of
57.2% [11], 54% [12] but higher than the 39.7% [13] reported in Egyptian studies conducted
Table 3. Distribution of serological and molecular markers of HBV in relation to demographics.
Variables Frequency n (%) HBV DNA n (%) HBsAg n (%) Anti-HBc n (%)
Age (yrs.)
� 5 147 (42.0)
6–10 113 (32.3) 2 (40.0) 2 (40.0) 3 (42.9)
11–15 88 (25.1) 3 (60.0) 3 (60.0) 4 (57.1)
> 15 2 (0.6)
Gender
Males 172 (49.1) 3 (60.0) 3 (60.0) 4 (57.1)
Females 178 (50.9) 2 (40.0) 2 (40.0) 3 (42.9)
HBV DNA
Positive 5 (1.4)
Negative 345 (98.6)
HBsAg
Positive 5 (1.4)
Negative 345 (98.6)
Anti-HBc
Positive 7 (2.0)
Negative 343 (98.0)
https://doi.org/10.1371/journal.pone.0257103.t003
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PLOS ONE Hepatitis B vaccination and hepatitis B virus infections
among vaccinated children. Also, the 56% sero-protection rate reported in the current study
compares favorably with the 56.7% reported among Iranian children [14] but lower than the
86.8% reported in South Africa [15], 90.0% reported in Brazil [16] and 88.7% reported in Ban-
gladesh [17]. It was observed in the current study that the anti-HBs levels declined with
increasing age. This finding is consistent with the findings of other studies [18,19]. Even
though anti-HBs levels declined with increasing age, the difference observed in the current
study was not statistically significant (p-value = 0.20). Additionally, no statistically significant
difference in sero-protection rate was observed between males and females (p-value = 0.93).
Some researchers have the opinion that a decline in the anti-HBs level below 10mIU/mL could
make the individuals vulnerable to HBV infection and that a booster dose of HB vaccine may
be needed [20]. However, other researchers are of the view that irrespective of the gradual fall
and loss in the anti-HBs level, if the primary hepatitis B vaccination is adequately performed in
healthy individuals, long term protection against HBV infection could be guaranteed and that
booster dose may not be needed [21,22]. A study conducted in Egypt reported age and gender
as the two main risk factors associated with non-sero-protection and that the risk was signifi-
cantly higher in girls than boys [11]. It was observed in the current study that there was no sta-
tistically significant difference in non-sero-protection levels among the different age groups
(p-value = 0.11) and between males and females (p-value = 1.0), a finding which is consistent
with that of studies conducted in the USA [23] and Iran [24] but at variance with the findings
of Salama et al.[11].
In the current study, it was observed that there was no statistically significant difference
in sero-protection rate between participants with a history of hospital admission, open
abscess, surgical operation, blood transfusion and participants with no such history (p-
value = 0.29) a finding which is at variance with that of Salama et al. [11] who reported that
children with the above-mentioned clinical history had significantly higher non-sero-pro-
tective rates compared to children with no such history (p-value<0.001). HBV infection
was not detected among participants � 5 years suggesting that there was no perinatal infec-
tion. This observation compares favorably with the findings of Soliman et al. [25] who
reported that none of the Egyptian children aged < 5 years tested positive for HBsAg but
another Egyptian study reported a prevalence of 0.8% among children aged � 6 years [26].
However, 1.4% of the participants aged between 6–15 years were positive for HBsAg/HBV
DNA while 2% of the children within the same age bracket were anti-HBc positive. All the
participants who were HBsAg/HBV DNA positive were anti-HBc positive. The two partici-
pants who were anti-HBc positive but HBsAg negative [anti-HBc (+ve)/HBsAg (-ve)] did
not have detectable HBV DNA indicating that there was no presence of occult HBV infec-
tion. Three mothers of the five participants who tested positive for both HBsAg and anti-
HBc [anti-HBc (+ve)/HBsAg (+ve)] did not know their HBV status (data not shown) and
therefore we could not tell whether the infected children contracted the HBV infection peri-
natally or horizontally. However, two mothers of the five participants who tested positive
for both HBsAg and anti-HBc [anti-HBc (+ve)/HBsAg (+ve)] were negative for HBsAg/
HBV DNA (data not shown) indicating that the participants might have contracted the
HBV infection horizontally. All the five participants who tested positive for HBsAg and the
seven participants who tested positive for anti-HBc had anti-HBs titer of < 10mIU/mL indi-
cating that they were not sero-protected. The 1.4% HBsAg sero-positivity rate reported in
the current study compares favorably with the findings of Wu et al. [27] who reported an
HBsAg sero-positivity rate of 1.5% among vaccinated children in China. HBsAg sero-posi-
tivity rate reported in the current study was higher in males than females, although not sta-
tistically significant. The finding is consistent with that of Odusanya et al. [28] who
reported that there was no statistically significant relationship between HBsAg sero-
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PLOS ONE Hepatitis B vaccination and hepatitis B virus infections
positivity rate and gender. The 2.0% anti-HBc sero-positivity rate reported in the current
study compares favorably with the findings of other studies [29].
Conclusion
From this study, it was observed that 56% the study participants attained sero-protection
status after primary hepatitis B vaccination but 44% of the participants who had been
fully vaccinated against HBV still remain unprotected and could be susceptible to HBV
infection. The prevalence of HBV infection as determined by HBsAg/HBV DNA positiv-
ity was 1.4% while anti-HBc sero-positivity was 2%. Further studies need to be conducted
to understand the factors related to the sero-conversion and sero-protection rate in the
West Gonja Municipal in the Savanna Region of Ghana. Additionally, further studies
need to be conducted across the country to assess the effectiveness of HB vaccination in
the country.
Limitations of the study
This study did not evaluate the effectiveness or efficacy of the hepatitis B vaccine but rather
evaluated the ability of hepatitis B vaccination in providing protection thereby reducing the
susceptibility of the vaccinated participants to the HBV. Also, age-matched unvaccinated con-
trols residing in the same area were not recruited into the study to enable us determine
whether the prevalence of HBV infection was the same in vaccinated and unvaccinated group
so as to determine the efficacy of the vaccine in the current study.
Supporting information
S1 File. Questionnaire used in the study.
(PDF)
Acknowledgments
We wish to sincerely thank all those who contributed to developing this new research, particu-
larly, the research participants and those who helped with recruitment, sample collection, labo-
ratory testing and data entry. Eddie-Williams Owiredu, Isaac Kusi-Amponsah, Hamdiyat
Mustapha M-asheda, Alimatu Braimah and Alhassan Amina.
Author Contributions
Conceptualization: Theophilus Quaye, Patrick Williams Narkwa, Mohamed Mutocheluh.
Formal analysis: Patrick Williams Narkwa, Mohamed Mutocheluh.
Funding acquisition: Patrick Williams Narkwa, Mohamed Mutocheluh.
Investigation: Theophilus Quaye, Seth A. Domfeh, Gloria Kattah.
Project administration: Seth A. Domfeh, Gloria Kattah.
Resources: Theophilus Quaye.
Supervision: Patrick Williams Narkwa, Mohamed Mutocheluh.
Writing – original draft: Theophilus Quaye.
Writing – review & editing: Patrick Williams Narkwa, Seth A. Domfeh, Gloria Kattah,
Mohamed Mutocheluh.
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