India Fights Hepatitis B with Infant Vaccinations

Hepatitis B vaccines deliver 90 percent protection from the virus

new born baby with mom

A new Indian study shows that many newborns are protected from hepatitis B infection whether they get the immunization in the hospital or at home.

The good news is the hepatitis B vaccine gives more than 90% protection to people who get the vaccine.

This research study compared the birth-dose in hospital to the 6 week dose for home births.The difference later in life was small. Unvaccinated children had a 4.6% rate of infection.

For this study, blood samples from 1-5-year old children were collected to measure antigen and antibodies of hepatitis B virus.

These researchers found that children who were given complete vaccination (with or without birth-dose of hepatitis B vaccine) had a similar level of protection against infection.

“If the mother is a hepatitis B carrier, especially if she is e-antigen positive, the baby must be vaccinated at birth,” Jacob Puliyel, the study's primary author and a pediatrician at St Stephens Hospital in Delhi.

However, in India, which introduced the HepB vaccine around 2006, approximately 61 percent of women deliver at home rather than in a health facility, making it next to impossible for health providers to administer newborn vaccines.

However, India is home to an estimated one-third of the world’s unvaccinated children, meaning that many children still do not receive any HepB vaccine at all

This study’s findings are in contrast with the update from the Advisory Committee on Immunization Practices (ACIP) and CDC.

On January 12, 2018, the ACIP issued the following recommendations:

  • universal hepatitis B (HepB) vaccination within 24 hours of birth for medically stable infants weighing ≥2,000 grams;
  • testing HBsAg-positive pregnant women for hepatitis B virus deoxyribonucleic acid (HBV DNA);
  • postvaccination serologic testing for infants whose mother’s HBsAg status remains unknown indefinitely (e.g., when a parent or person with lawful custody surrenders an infant confidentially shortly after birth);
  • single-dose revaccination for infants born to HBsAg-positive women not responding to the initial vaccine series;
  • vaccination for persons with chronic liver disease (including, but not limited to, those with hepatitis C virus [HCV] infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal); and
  • removal of permissive language for delaying the birth-dose until after hospital discharge.

Anyone can become infected with hepatitis B virus at any time during their lives. Hepatitis B is a serious liver disease caused by the hepatitis B virus. The virus can enter the bloodstream, attack the liver, and cause serious damage, says the Centers for Disease Control and Prevention (CDC).

When babies get infected, the virus usually remains in the body for a lifetime, which is called chronic hepatitis B.

For example, babies can get hepatitis B virus from their infected mothers at birth, and children can get it if they live with or are cared for by an infected person, or even if they share personal care items (toothbrush) with an infected person.

Currently, about 1 out of 20 people in the United States have been infected with the hepatitis B virus.

In the USA, there are 2 vaccines approved by the FDA that protect against hepatitis B:

  • The hepatitis B vaccine protects infants, children, and adults from hepatitis B
  • The hepatitis A and B combination vaccine protects adults from both hepatitis B and hepatitis A

The research findings have published in the Indian Journal of Pediatrics. The research team did not disclose any conflicts of interest, and included: Jacob Puliyel (St Stephens Hospital, New Delhi), Pathik Naik(Pathik Children’s Hospital, Surat), Ashish Puliyel (Consumer CAP HPI, London), Kishore Agarwal (Sardarmal Khandaka Memorial Hospital, Jaipur), Vandana Lal and Nimmi Kansal (Lal Path Labs, New Delhi), Devki Nandan (Ram Manohar Lohia Hospital), Vikas Tripathi and Prashant Tyagi (Pt Madan Mohan Malaviya Hospital, New Delhi), Saroj K Singh (Nazareth Hospital, Allahabad), Rajeev Srivastava (SGRRIM & SMI Hospital, Dehradun), Utkarsh Sharma (Tirthanker Mahavir Medical College, Moradabad), and V Sreenivas (AIIMS, New Delhi).

Source of Funding: Indian Council of Medical Research, Delhi.