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Introducing Hepatitis B Vaccine in Universal Immunization Programme in India - A Brief Scenario

Burden of Disease Hepatitis B is a major public health problem worldwide. Approximately 30 percent of the worlds population, i.e. about 2 billion persons, have serological evidence of current or past HBV infection. Of these, an estimated 350 million have chronic HBV infection and at least one million persons die annually from HBV-related chronic liver disease, including cirrhosis and liver cancer.

India has intermediate endemicity of Hepatitis B, with Hepatitis B surface antigen (HBsAg) prevalence between 2% and 7% among populations studied. The prevalence does not vary significantly by region in the country. The number of HBsAg carriers in India has been estimated to be over 40 million (4 crore). It has been estimated that, in India of the 25 million infants born every year, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection.

Introducing Hepatitis B Immunization as part of UIP The Hepatitis B Project was initiated in India in the year 2002 with support of Global Fund for vaccines & Immunization (GAVI). An agreement was signed by Govt. of India, Inter Agency Cooperation Committee (IAC) & the GAVI for this project. The partners from IAC for this initiative include W.H.O., UNICEF, USAID, PATH, World Bank, DIFID & European Commission.

In the first quarter of year 2003 the vaccination of infants in the slums of 15 selected cities was initiated. In the last quarter of the year 2003 it was expanded to cover all the infants of 33 selected districts of the country. The list of project cities & districts is stated under the link having the title - Frequently Asked Questions and Answers.

The second phase of the project is planned to be initiated under the new application submitted by the Govt. of India in Sept. 2004 to the Global Alliance for Vaccines & Immunization (GAVI). In this phase of the project the continuation & improving the vaccination coverage of Hepatitis B & DPT vaccination is planned in the existing project area. In addition to this the coverage of about 1.49 million non slum infants is also planned in the project cities from year 2005 to ensure equity, improve immunization coverage & also the epidemiological impact in the selected geographical area. In this second phase of the project another important area being covered by the Govt. of India is improving the Injection Safety. Under this initiative steps are being taken to ensure the availability of AD syringes in all the immunization sessions of the country by the end of year 2005.

Role of W.H.O. All the members of the IAC have been contributing their vision & support in planning & policy decisions related with the project. The technical assistance for planning, trainings & monitoring of the project is being provided by W.H.O. The specific activities assisted by W.H.O. India office include developing Operations Guide for the Program, help in preparation & review of training material, Training of Trainers & conducting workshops of Program Managers along with other programme partners such as PATH & UNICEF. The periodic feed back on analysis of the immunization performance reports is being provided to the project cities & districts & the system of procurement and distribution of Hepatitis B vaccine & AD syringes is being made more effective by taking into account the actual utilization and balance stock, with the technical assistance being provided by the W.H.O. India office. Recently in August 2004, a Rapid Assessment of Hepatitis B Introduction in India has been completed by the WHO-SEARO & India Office with the participation of experts from WHO, PATH, UNICEF & Govt. of India.

The Training Modules developed for Medical Officers & Vaccinators & further technical details about introduction of Hepatitis B vaccine & AD syringes in the country are available from separate links connected with this brief.

Markers for transfusion-associated hepatitis in north Indian blood donors: prevalence and trends.
Singh B, Verma M, Verma K.

Department of Regional Blood Transfusion Centre (East) and Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, India.

Transfusion-associated hepatitis is a great problem in developing countries including India due to endemic hepatitis infections and a lack of voluntary donors, trained personnel, and funds. The prevalence of post-transfusion hepatitis B and C in India is about 1-5% and 1%, respectively. A total of 128,589 blood donors were screened for hepatitis B surface antigen (HBsAg) and 76,089 donors were screened for anti-hepatitis C virus (HCV) from 1997 - 2002. Data were tabulated annually. Out of the total 83.6% were replacement donors. Our study concluded that the prevalence of HBsAg and antibodies for HCV ranged between 1.7 - 2.2% and 0.25 - 0.9%, respectively among all of the donors. Seropositivity was definitely higher in replacement donors than in voluntary donors. Based on these results, we recognize an urgent need to establish a non-remunerated voluntary donor base in India. A stringent deferral system should be developed. The use of sensitive laboratory tests and the addition of core antigen (anti-HBc) to the mandatory screening test list would further reduce the incidence of post-transfusion hepatitis.