New Delhi: Bangladesh, Bhutan, Nepal and Thailand have become the first four countries in the World Health Organisation’s (WHO) Southeast Asia region to successfully control hepatitis B as the prevalence of the disease has been reduced to less than 1% among children below five, according to a report in the Hindu.
While India introduced the Universal Immunisation Programme (UIP) in 2002 and scaled it up across the country in 2010 to combat hepatitis B, its prevalence amongst children less than five has not reduced to below 1%.
Preventing hepatitis B infection in infancy would reduce chronic infections and cases of liver cancer and cirrhosis (scarring of the liver) in adulthood.
According to estimates from the WHO, viral hepatitis caused 1.34 million deaths globally in 2015. In India, it is estimated that there are four crore people suffering from hepatitis B and 0.6-1.2 crore people suffering from hepatitis C.
The WHO estimated, in 2015, that coverage for hepatitis B third dose had touched 86%, but the birth dose coverage was only at 45% with large variations across states.
Even though the vaccine for hepatitis is administered alongside diphtheria, pertussis and tetanus (DPT) and oral polio vaccine at six, ten and 14 weeks, studies have indicated that coverage for the hepatitis B vaccine is significantly lower.
Hepatitis B coverage received a shot in the arm after the introduction of a pentavalent vaccine on a pilot basis in Kerala and Tamil Nadu in December 2011 and its national roll-out in 2014-2015.
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The hepatitis B birth dose, rolled out in the national programme in 2008, prevents vertical transmission from the mother to child if administered in the first 24 hours after birth. Administering the birth dose to cut vertical transmission is needed as about 70-90% newborns infected this way become chronic carriers of hepatitis B, and about 20-30% carriers in India are due to vertical transmission.
Several patients remain asymptomatic for a long period of time and since prenatal testing is not very common, the virus tends to go undetected in children and they do not know they have it until much later in adulthood.
According to a report by the ministry of health and family welfare, there was only 45% coverage of the health dose in 2015 and 60% in 2016. Despite the fact that 80% of deliveries are in healthcare institutions in India, the coverage for the birth dose vaccine has been low with 55% in 2015 and 67% in 2016. The coverage amongst institutional deliveries for the birth dose was reported to be 71% as of March 2017.
A factor that contributes to the low coverage of the birth dose in healthcare facilities is the fear of wasting vaccines when a ten-dose vial is used. However, most workers are unaware that WHO recommendations allow for a hepatitis B open vial policy for the vaccine which can be kept for a maximum duration of 28 days for use in other children.