Virtues Vaccination

Treatment apart, the only cost-effective method of controlling Hepatitis B would be to break the cycle of the virus. “Hepatitis B can be nipped in the bud, as it is the only stain which can be transmitted from the mother to the child,” says A. K. Patwari, Professor of Paediatrics and Chief, Division of Paediatric Gastroenterology and Nutrition, Lady Hardinge Medical College.

According to S. K. Mittal, Professor and Head of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, “The contribution of perinatal (from mother to child) transmission of hepatitis is very significant in India. Nearly one-third of the overall pool of chronic carriers are get infected this way.” Interestingly, in a sample testing conducted on 1,000 women, nearly 4.3 per cent of the mothers tested at the time of delivery are hepatitis positive. Out of this, 0.7 per cent were tested positive for Hepatitis Be antigen, which means there are 90 per cent chances of these mothers transmitting their diseases to the child. Also, of the 250 lakh births that take place in India every year, 3 lakh babies are likely to become chronic carriers. Hepatitis can be prevented either by vaccinating children or by preventing infection in expectant mothers.

To prevent infection, it is necessary for people handling blood products in hospitals and nursing homes to take extra precaution. Surprisingly, barring a few hospitals, the staff of most hospitals and nursing homes are not vaccinated. This includes a majority of medical students. “This, despite the fact that you need as little as .00001 ml of blood to get infected.

What’s more, most people are also not aware of the fact that Hepatitis B is more infectious than HIV,” says Anupam Sibal, Consultant Paediatric Gastroenterologist and Hepatologist, Indraprastha Apollo Hospital. Says Rakesh K. Tandon, Head of Gastroenterology, All India Institute of Medical Sciences, “As far as breaking the cycle of the virus is concerned, India will have to follow the example of the over 80 countries who have already vanquished the virus through mass immunisation or vaccinating children below one year of age”.

The basic impediment is the cost involved. “The government has worked out the cost for the immunisation to about Rs 350 crore,” says Tandon. The money is not forthcoming, despite the fact that it is peanuts compared to the amount of money laundered in the scams reported in this country. But there are other reasons too. “Only 20 per cent of the deliveries are instutionalised, the rest are carried out at home or by untrained helpers.

In the latter cases, the child cannot be vaccinated within 48 hours of birth. If vaccinated later than that, the result of the vaccination is not as effective. This defeats the very purpose of mass vaccination,” says Mittal.

Another aspect which needs attention is that expectant mothers should be monitored more carefully because if a baby less that a year old gets infected with Hepatitis B through the mother, there are 90 per cent chances of chronic infection, and 25 per cent chance of death due to a liver disease. Even when not infected during the prenatal period, children of HBV-infected mothers remain at high risk of acquiring chronic infection by person-to-person (horizontal) infection during the first five years of life.

More than 90 per cent of these infections can be prevented if HBV-infected mothers are identified and their infants vaccinated. Hepatitis B vaccination and one dose of HBIG, (the immunologic substance which acts as immediate first aid in case the infection is transmitted from the mother to the child), administered within 24 hours of birth, are 85 to 95 per cent effective in preventing both HBV infection and the chronic carrier state.

Hepatitis B vaccine administered alone in three or four dose schedule, beginning within 24 hours of birth, is 70 to 95 per cent effective in preventing the infection from passing from the mother to the baby. “Of course, the additional reduction in acute hepatitis B and hepatitis B-associated chronic liver diseases resulting from mass infant vaccination can become apparent only after a number of years,” adds Patwari.

“It is also important to closely monitor the child right from the delivery. Though most newborns develop jaundice (known as physiological jaundice) by the third day of the birth, it should ideally clear out within a week’s time. If it continues over a longer period of time or if it appears after two to three weeks from birth, the child needs closer monitoring and should be tested for Hepatitis. The golden rule is earlier the detection and vaccination, greater are the chances of survival,’ says Sibal. In case the child has not been vaccinated and develops the infection as he grows, the cost of treatment works up to lakhs.

Still, the chances of the child getting rid of the infection are only 50 to 60 per cent. This makes it all the more important to either prevent or nip the infection in the bud.