Iraq's Hepatitis B Prevention Challenges and Opportunities: Focusing on Vertical Transmission and Vaccine Series Completion

Hepatitis B virus (HBV) infection remains a significant public health concern in the Eastern
Mediterranean Region. This study aimed to assess HBV vaccination coverage, identify barriers to
vaccination, and determine prevalence rates among diverse risk groups in Iraq. A cross-sectional
analysis was conducted using national vaccination and screening data from healthcare facilities
across Al-Najaf city. Vaccination records were analyzed for high-risk populations, including
healthcare workers (HCWs), contacts of diagnosed patients, and occupational risk groups. HBV
screening results were examined across 15 distinct risk categories (n=103,550). Barriers to
vaccination were assessed through structured surveys of healthcare providers. Among 103,550
individuals screened, overall HBV prevalence was 0.095% (98 positive cases). Highest absolute
numbers of cases were found among surgical patients (24.5% of positives), blood donors (22.4%),
and pre-marital screening participants (12.2%). Children born to infected mothers showed 100%
positivity rate, while contacts of diagnosed patients demonstrated 3.57% positivity. Vaccination
data revealed significant dose completion challenges, with 624 first doses administered compared
to only 335 third doses completed. Healthcare workers received 73.4% of all vaccine doses. Primary
barriers to vaccination included vaccine availability (50%), safety concerns (45%), and insufficient
training (40%). Non-compliance among HCWs stemmed from perceived ineffectiveness (37%),
perception of low disease prevalence (35%), and safety concerns (30%). This study identifies critical
gaps in Iraq's HBV prevention strategy, particularly regarding vertical transmission prevention and
vaccine series completion. The substantial drop off between first and third vaccine doses highlights
systemic challenges in the vaccination program. Targeted interventions should address identified
barriers, particularly vaccine supply issues and safety concerns. Strengthening screening and
vaccination efforts for contacts of diagnosed patients and children born to infected mothers
represents a high-impact opportunity for infection control. Comprehensive policies addressing
gender disparities in screening access and enhanced professional education are needed to improve
Iraq's HBV prevention landscape.