Rajasthan Government has recommended in
2011 that hepatitis B vaccination be given to all
institutional delivered babies within 24 hrs of birth as 0
dose so as to prevent vertical transmission. The remaining
recommended doses are to be given at 6-10-14 weeks. IAP
Immunization Schedule 2009-10 recommended five schedules
viz. birth, 1 and 6 months; birth, 6 and 14 weeks; 6, 10
and 14 weeks; birth, 6 weeks, 6 months; and birth, 6
weeks,10 weeks, 14 weeks. The recent Consensus
Recommendations of IAPCOI [1] has recommended the
0-6wks-6months schedule, the first dose to be administered
at birth, second dose at 6 weeks and third dose at 6 months.
The reason being it is more closer to immunologically ideal
and most widely used 0-1-6 months schedule, and also
conforms to latest ACIP recommendations wherein the final
dose in the Hepatitis-B vaccine series should be
administered no earlier than 24 weeks and at least 16 weeks
after the first dose [2] .
Therefore, the question arises as to the
rationality of the recommendation followed in the above
4-doses schedule, wherein the first dose is given within 24
hours of birth for institutional deliveries only. With
these, we will be missing out on those delivered outside the
hospital and also those coming for vaccination beyond 24
hours of birth even in case of hospital deliveries also
which happen many a time. If on the other hand if it is
beneficial, should we recommend it?
As to the other schedules where 6-10
weeks schedule are also included, should we altogether forgo
it ,despite the programmatic implications and logistic
issues as it is not ideal immunologically and does not
conform to the classical schedule of 0-1-6 months.
Coming back to the schedule followed
here, where the birth-6-10-14 weeks are recommended, and
based on what we have noted above, it is far from being
ideal. First, the ‘Zero’ dose benefits only a section of a
population and deprives those newborns delivered outside and
also those of institutional deliveries presenting after 24
hours of life. Secondly, the schedule with its recommended
dose at 10 and 14 weeks dose not conform to the ideal
immunological response and schedule as recommended under
ACIP guidelines [2]. So what should be the further course to
be taken here in the context mentioned above.
References
1. Indian Academy of Pediatrics Committee
on Immunization (IAPCOI). Consensus guidelines on
recommendations on immunization,2008.Indian Pediatr.
2008;45:635-48.
2. Recommended Childhood and Adolescent Immunization
Schedules-United States,2012,Committee on Infectious
diseases.Pediatrics; 385 Available from:http://paediatrics.aappublications.org/content/129/385.full.html
Accessed on March 4,2012.