The legal framework
South Africa introduced hepatitis B into routine infant immunisation in 1995, starting at six weeks. For many years there was no birth dose, which left transmission from mother to child inadequately addressed; a birth dose has since been introduced. Antenatal screening has historically not been universal, another difference from most comparable countries.
South Africa introduced hepatitis B into the expanded programme on immunisation in 1995, from six weeks of age, and added a universal birth dose to the schedule more recently — a significant change, since the six-week start left the perinatal window open. Prevalence is intermediate, and co-infection with HIV complicates management.
Key points
| Infant vaccination | In the routine schedule since 1995, from six weeks |
|---|---|
| Birth dose | Added only recently, after years without one |
| Antenatal screening | Historically not universal; practice is changing |
| Prevalence | Intermediate to high, varying by province |
| HIV co-infection | Common, and changes both monitoring and treatment |
| Treatment | Available in the public sector, often alongside HIV treatment |
| Testing | Available at clinics; ask for it explicitly |
In practice
- Ask for hepatitis B testing during pregnancy: it has not historically been routine.
- Ask for the birth dose for the newborn within 24 hours.
- If you are living with HIV, ask whether your treatment also covers hepatitis B — several regimens do.
- Household contacts of a carrier should be tested and vaccinated.
Cost and coverage
Testing and treatment are free in the public sector.
Where to go
- Public clinics and community health centres.
- Hepatology and infectious disease services of academic hospitals.
- HIV clinics, which often manage co-infection.
Worth knowing
If you are living with HIV, the antiretroviral regimen you take may already treat hepatitis B. Stopping or changing it without accounting for that can cause a dangerous flare — always mention both infections.
Frequently asked questions
Has the birth dose been added in South Africa?
Yes, a birth dose was added to the schedule to close the gap left by starting at six weeks, which is the period when mother-to-child transmission occurs. Ask that it is given and recorded in the Road to Health booklet.
Why does the birth dose matter so much?
Because transmission from mother to baby at birth is the route most likely to produce a lifelong chronic infection — an infant infected at birth has a very high chance of never clearing the virus, whereas an adult usually does. A vaccine dose within twenty-four hours of birth, with immunoglobulin where the mother is positive, prevents this in the great majority of cases.
Official sources and links
- gov.za — official government portal
- South African Human Rights Commission — constitutional rights body