‘Sebodo T. 1994, Immunization to hepatitis B 51 IMMUNIZATION TO HEPATITIS B VIRUS INFECTION USING TWO DIFFERENCE SCHEDULE IN CHILDREN ‘Teluk Sebodo and Muhammad Juttrio Department of Child Health, Faculty of Medicine Gacjah Mada University Yogyakarta Immunization program in children under 12 months of age had bean done by the Department of Health using plasma derived hepatitis B vaccine with the dose 10 meg at 0;1 and 6 months, There were two schedule in the HBV vaccination such as short schedule (0;1 and 2 months) and long schedule (0;1 and 6 menths). Milne and Moyes (1988) suggested that it could ba easier to administered such program and ta obtain good compliance to short schedule than long schedule. ‘The aim of this study is to know the response of hepatitis B vaccination using wo difference schedule. ‘Two hundred and two children aged 1 - $5 months wera included in this study and divided into two groups. Group | consisted of 60 male and 38 femate, group Il consisted of 50 male and 54 female. Children aver 12 months of age were screened for HBsAg and anti-HBs, children 12 months or less were directly vaccinated, The dase were 10 meg plasma derived hepatitis B vaccine, injaction was done intramuscularly in ~ the upper deltoid, 1 month after third injection ail cases were examined for anti-HBs. ‘There were no significant difference in the sero-conversion and anti-HBs mean titers between two groups, Key word: vaccination, hepatitis B, response, schedule. Introduction The serious consequences of Hepatitis B virus (HBV) infection are the development of the persistent viral carrier state, which occurs between 70% or 90% of acute infection in infancy and decline to 6% and 10% of infection which occur after 6 years of life (Maynard, et al 1988) . In Indonesia, as hyperendemic area of HBV infections, these figures are critical tothe determination of strategies for prevention of HBV through vaccination, especially in the early stage of life. Immunization program in children under 12 months of age had been done by the department of health using plasma derived Hepatitis B vaccine with the dose 10 mcg at 0.1 and 6 months. There are two schedule of hepatitis B vaccination such as short schedule (0.1 and 2 months) and long schedule (0.1 and 6 months). Milne and Moyes., (1988) (2), suggested that it may be easier to administered such program and to obtain betta compliance the short schedule than long schedule. The aims of this study is to know the response of Hepatitis B vaccine using two difference schedules. Berita Kedoktaran Masyarakat X/2) 1904 ISSN0215-193652 ‘Sebodo T. 1994, immunization to hepatitis B Material and Methods a. Materiai Two hundred and two children ranging from 0 to 55 months were included in this study. Allchildren came from well baby clinic of DR. Sardjito General Hospital from January to December 1992, Randomly divided into two groups, group consisted of 60 male and 38 female, group II consisted of 50 male and 54 female. Children over 12 months of age were screened for HBsAg and anti- HBs, children 12 months of age or less were directly vac- cinated. The dosage were 10 meg of plasma derived Hepatitis B vaccine, injection was done intramuscularly at the upper deltoid region for group I at months 0, 1 and 3, group II at months 0, 1 and 6. One month after the third injection, all cases were examined for anti- HBs. HBsAg and anti-HBs were determined with enzyme immuno-assay, HBsAg using hepanos- tica HBsAg uniform II and anti-HBs using hepanostica anti-HBs (Organon). Comparison between groups were described using contingency table, and X’ statistic was used to test the association of two variable. The difference between mean values, were assessed using student t-test and chi- square, anti-HBs positive was 10 mIU/ml. Result The sex distribution of all cases were 60 male and 38 female in group I, and $0 male and 54 female in group II. There wasa significant difference between two groups. P < 0.005 lable 1). ‘Table 1. Sex distribution of the cases. P< 0.005 The mean of age in group | were 7.94 months, group II were 7.8 months. There was no significant difference between two groups. P = 0.900 (Table 2) ‘Table 2. Age Distribution of the cases. Mean of ages ‘SD /SEM 7.94 9.2/0,91 7.08 10.0/1.0 ISSN 0215-1996 Berita Kedokteran Masyarakat X(2) 1994‘Sebodo T. 1994, Immunization to hepatitis B 53 It was shown that in the group I, anti-HBs were positive in 92 out of 98 cases (91.84%), in group II were positive in 101 out of 104 cases (92.9%). The mean of anti-HBs titers were 5252 mIL//ml in group I and 4185 mIU/ml in group II. No significant difference was found ‘petween two groups in seroconversion and anti- HBs mean of titers (Table 3). Table 3. Seroconversion rate and Antl-HBs mean titer in mIU/mi by E2A In both groups. Noof subjects (10 miUm) Anti HBs titer, oolUfmd mean SD. Discussion Theavailability of plasma derived hepatitis B vaccine, which was safe, immunogenic, protective in Chimpanzee (Hilleman, et al. 1975) and in high risk population in the United States (Szmuneas., et al. 1980), makes possible to establish, the immunization program, to eliminate a hepatitis B virus infection especially in young babies. Strategies for immunization maybe initially divided according to the endemicity of hepatitis B. In low endemicity, vaccine prophylaxis has generally been recommended for particular high risk groups, most of whom are adults. In areas of high endemicity, itis clear that to have any substantial effect, immunization program must be in a large scale and mainly cover of infant, For primary immunization, the two schedules are currently used for plasma derived hepatitis B vaccine such as short schedule (0.1 and 2 months) and long schedule (0. 1 and 6 months}. The short schedule maybe most easier to administer in large scale of immunization program, because it will be induce anti-HBs 3 months earlier than long schedule. Study in New Zealand reported that there appears to be no disadvantage in using short schedule (2 months course) (Milne and Moyes, 1988). It is confirmed with our study that no significant difference was found in seroconversion and anti-HBs mean titer between two groups. (P = 0.142 ; P = 0,150). Berita Kedokteran Masyarakat X(2} 1994 ISSN 0215-1996s ‘Sebodo T. 1994, Immunization to hopatitis B It is therefore concluded that in Indonesia as a hyperdemic areas, mass vaccination program using short schedule, will induce anti-HBs earlier, easier to administered, increase coverage of basic immunization in children. And this vaccination could save thousands of children from becoming carriers. References Hilleman, M.R,, Buynek,£.B., & Roehm, R.R. 1975 Purified and inactivated human hepatitis B vaccine, Progress report Am | Med Sci. 270: 401-404, Maynard, JE, Kane, M.A., Alter, MJ., & Hedler, S.C. 1988 Control of hepatitis B by immunization Global Perspective. Viral Hepatitis and liver disease p. 987-989. Milne, A & Moyes, C. 1988 Response to Hepatitis B vaccine in New Zealand Children: Using low doses in a two month versus six months schedule. Viral Hepatitis and Liver disease. Allan R.Liss. p977979. ‘Szmuness, W., Steven, C.E., Harley, EJ. 1980 Hepatitis B vaccine demonstration of efficacy in controlled clinical trial in high risk population in the United States. Niu Engf.f.Med.403:833-841. ISSN 0215-1996 Berita Kedokteran Masyarakat X(2) 1994