HEPATITIS B (Hep B) VACCINE

Recommendations for use The hepatitis B vaccines are of public health importance. The government of India has initiated hepatitis B vaccination since June 2002 with expansion in a phased manner. For office practice, the IAPCOI recommends offering hepatitis B vaccine to all children. Hep B vaccine may be given in any of the following schedules: (i) Birth, 1 and 6 months (ii) Birth, 6 and 14 weeks (iii) 6, 10 and 14 weeks (iv) Birth, 6 weeks, 6 months (v) Birth, 6 weeks,10 weeks, 14 weeks Immunologically 0 1 6 months schedule of hepatitis B immunization has been most widely used and proven to be ideal with high antibody titers at the end of the vaccination. However Hep B vaccine is a T-cell dependent vaccine and the titers at the end of immunization schedule may not be important so far as it is well above the protective level. There would occur anamnestic response with the titers going up, should there occur contact with the virus again in future. Also now that Hep B vaccination is integrated into the existing immunization program (EPI) in India, due to operational issues at a national level one has to piggy back on the available contacts for routine immunization i.e. DTP which is given at 6, 10 and 14 weeks of age. At the same time, birth dose has to be given to cover for the vertical route. Hence IAP COI recommends 0 6 14 wks schedule for public health. In case birth dose has been missed, 6 10 14 wks schedule can be followed. In office practice, one can still use 0 4/6wks 6 months schedule. As of now, from the data available, none of the above schedules needs a booster. Catch up vaccination with Hep B vaccine as a 0, 1, 6 schedule should be offered to all children/ adolescents who have not been previously vaccinated with Hep B vaccine. This is to address problems related to horizontal mode of transmission of the virus. Prevaccination screening with anti HBsAg antibody is not cost effective and is not recommended. Catch up vaccination is particularly important for contacts of HBsAg positive patient. Prevaccination screening for HBsAg should be done in these contacts. All available brands of Hepatitis B vaccine are equally safe and effective and any may be used. Interchange of brands is permitted but not routinely recommended. Combination vaccines containing Hep B are discussed separately.