Viral hepatitis remains a major public health challenge, particularly in low and middle-income countries. In 2022, around 304 million people were living with hepatitis B and C worldwide. Among them, an estimated 254 million people were infected with the hepatitis B virus (HBV), with 6,000 new infections occurring daily [1] . Between 2019 and 2022, viral hepatitis-related deaths rose to 1.1 million annually, with HBV accounting for 83% of these fatalities. According to the World Health Organization (WHO), the African region accounts for 63% of new HBV infections [1] - [3] . HBV is the leading cause of acute hepatitis, chronic liver disease, and hepatocellular carcinoma (HCC) in sub-Saharan Africa, where it is responsible for 44% of cirrhosis cases and 47% of HCC cases [4] [5] .

HBV is primarily transmitted vertically from mother to child during childbirth, a mode of transmission that perpetuates the virus within the population [6] - [9] . This route significantly increases the risk of long-term complications, such as cirrhosis and HCC, which account for 96% of hepatitis B- and C-related mortality [10] [11] .

The WHO has identified vaccination as a cornerstone of HBV prevention [12] . However, in 2022, only 45% of infants globally received a hepatitis B vaccine within 24 hours of birth, with coverage in the African region as low as 18% [1] [12] . Although routine childhood HBV vaccination coverage in Africa reached 72% in 2021, this remains below the global target of 90% global target of 90% [12] [13] . Diagnosis and treatment are even more concerning, with only 2% of infected individuals diagnosed, and fewer than 0.1% received treatment in 2021 [13] . Continuous monitoring of prevalence trends is therefore essential for optimizing HBV prevention and managing strategies.

In Burkina Faso, a national study conducted in 2018 by Nicolas et al. estimated HBV prevalence at 9.1% using data from the 2010 DHS [14] . Additionally, local studies in Ouagadougou, in 2014, reported higher rates (14.47%) [8] , while prevalence among high-risk groups, such as HIV-positive individuals (12%) [15] , blood donors (14.96%) [16] , and pregnant women (11.11%) [17] , further underscores the country’s high endemicity. Despite the introduction of the HBV vaccine into Burkina Faso’s Expanded Program on Immunization (EPI) in 2006, challenges persist. Until 2020, the first vaccine dose was administered at 8 weeks of age rather than within 24 hours of birth, as recommended by the WHO for high-endemicity settings [18] . This delay increases the risk of vertical transmission, which is the dominant mode of HBV spread in Burkina Faso [19] . Given the lack of recent post-vaccination data, this study aimed to assess the seroprevalence, sociodemographic disparities, and geographic heterogeneity of HBV infection in Burkina Faso’s general population, fifteen years (2006-2021) after the vaccine’s introduction into the EPI.

This study assessed the seroprevalence of hepatitis B virus (HBV) in Burkina Faso’s general population, using a nationally representative, population-based sampling design. The overall HBV seroprevalence was 9.3%, confirming the country’s high endemicity status (>8%) and underscoring the persistent risk of HBV infection despite control efforts.

Our findings are statistically comparable to those reported by Meda et al. (2018), who estimated a 9.1% seroprevalence based on samples from the 2010 Demographic and Health Survey (DHS) [14] . This similarity suggests that HBV prevalence has remained stable over the past decade, despite ongoing efforts by the government and health partners to reduce disease burden. One likely explanation is the suboptimal implementation of neonatal immunization. While the standard HBV vaccination schedule includes a birth dose followed by two additional doses within the first year of life, in Burkina Faso, the first dose was administered at 8 weeks from 2006 to 2022. This delayed initiation leaves neonates born to HBV-infected mothers vulnerable during the critical first four weeks of life, when vertical transmission is most likely.

Compared to other countries in the region, our results show both similarities and differences. In Togo, a screening campaign conducted in Lomé during World Hepatitis Day found an HBV prevalence of 16.36% among 1213 individuals [21] . In Nigeria, a systematic review and meta-analysis by Musa et al. (2015) [22] estimated HBV prevalence at 13.6%. These higher rates are partly attributed to lower vaccination coverage and insufficient national programs for HBV prevention and control. Conversely, lower seroprevalence has been reported in countries with more robust immunization strategies. In Benin, Kpossou et al. (2020) [23] reported a prevalence of 6% during a mass screening campaign. Morocco has achieved even lower rates: Sbai et al. (2012) [24] reported a 1.66% prevalence among working adults. These inter-country comparisons highlight the critical importance of early and widespread vaccine coverage in curbing HBV transmission.

In terms of sex-specific distribution, men had a slightly higher seroprevalence (9.8%) than women (8.9%), although the difference was not statistically significant. However, other studies have reported stronger gender disparities. For example, Yanogo et al. (2022) [25] found that men were 2.5 times more likely to be HBsAg positive than women. Meda et al. (2018) also reported a significantly higher prevalence in men (10.5%) than in women (7.8%), as did Sanou et al. (2025) [26] , with 10.7% in men versus 7.0% in women. The influence of sex hormones on immune function has been suggested as a possible explanation: androgens and estrogens modulate the immune response, particularly cytokine secretion, antigen presentation, and lymphocyte activity. Notably, female patients have been shown to achieve higher HBeAg and HBsAg clearance rates than males.

Age-specific analysis showed no statistically significant differences in HBV seroprevalence. The highest prevalence (10.6%) was observed among individuals aged 15 - 25 years, while the lowest (7.9%) occurred in those aged 45 - 55 years. Among children aged 5 - 15 years—born after HBV vaccine introduction in 2006—seroprevalence was 9.3%, which is unexpectedly high for a birth cohort eligible for vaccination since 2006. This observation suggests possible issues in vaccine coverage, vaccine efficacy, or cold chain management, and highlights the need for renewed attention to HBV control in this age group. This age group is the most vulnerable to developing chronic hepatitis B infection, especially children who have never received the vaccine, with a risk as high as 90%. Vaccination remains one of the most effective public health interventions for preventing HBV-related morbidity and mortality, particularly in newborns and children. While age was not associated with infection in our study, other contexts have shown age-related differences: in India, Ravindra et al. (2019) [27] found a higher HBsAg prevalence among adults than children.

Regarding marital status, HBV seroprevalence was 9.5% among married individuals, 8.5% among singles, and 8.6% among divorced or widowed persons. Although prevalence was slightly higher among married individuals, the differences were not statistically significant. Similar findings were reported by Tao et al. (2014) [8] , who found comparable HBV prevalence among married (15.52%) and unmarried (14.95%) individuals. Nevertheless, previous literature has suggested that women may be more susceptible to sexually transmitted infections due to greater biological exposure and differences in sexual behavior [27] .

A major finding of this study is the substantial regional heterogeneity in HBV prevalence. The highest rates were observed in Boucle du Mouhoun (15.1%) and Sud-Ouest (14.0%), both significantly above the national average. These findings caution against assumptions of epidemiological homogeneity across the country; a limitation often encountered in meta-analyses. Conversely, the Sahel region showed the lowest prevalence (4.2%). However, data collection in this region was limited to the regional capital due to security concerns, potentially leading to underestimation.

Previous studies have also highlighted regional disparities. Meda et al. (2018) [14] found the highest prevalence in the Est region (11.0%). Local studies have reported even higher rates: 27.6% in Dano (Sud-Ouest) [26] , and 14.1% in Tiéfora (Cascades) (Sanou et al., 2025), 14.5% in Ouagadougou (Centre) (Tao et al., 2014), and 14.3% in Nouna (Boucle du Nouhoun) [28] . These variations underscore the need for region-specific interventions, including tailored communication strategies, localized vaccination efforts, and targeted screening programs to effectively combat HBV transmission in Burkina Faso.

Fifteen years after HBV vaccination was introduced into the national immunization schedule, hepatitis B remains highly prevalent in Burkina Faso. The persistently high seroprevalence among children suggests gaps in the early administration of the vaccine. Strengthening routine immunization—particularly ensuring the timely birth dose—along with targeted regional interventions, is critical to controlling HBV transmission.

Despite sustained government efforts, Burkina Faso continues to face a high burden of hepatitis B virus (HBV) infection, with persistently elevated prevalence (9.3%) even among the post-vaccine generation. This underscores critical gaps in perinatal prevention, as the HBV vaccine was historically administered at 8 weeks of age rather than within the WHO-recommended 24-hour birth window in high-endemicity settings. The 2022 policy shift to universal timely birth dosing (within 24 hours of delivery in health facilities) marks a pivotal opportunity to disrupt vertical transmission. However, achieving impact will require strengthened health systems to ensure birth dose access for facility and home births, community engagement to address vaccine hesitancy, and integrated HBV screening in antenatal care to identify high-risk pregnancies. While our study lacked birth dose coverage data, future monitoring should evaluate this intervention’s effect on HBV seroprevalence trends in children under 5 years.

This study utilized serum samples originally collected for COVID-19 seroprevalence surveillance, which limited the availability of HBV-specific risk factor data such as vaccination status, exposure history, and behavioral practices. The absence of individual vaccination data prevents the study from distinguishing between vaccine failure and a failure to be vaccinated as the cause of the continued high prevalence in the younger cohort. Additionally, field accessibility constraints necessitated prioritizing data collection in secure urban centers in certain regions, affecting geographic coverage. Despite these limitations, the study’s large, nationally representative sample size and robust weighted sampling strategy ensure the reliability of HBV prevalence estimates at the national level.