What are the recommendations for Hepatitis B (HBV) vaccination in India?

Hepatitis B Vaccination Recommendations in India

All individuals in India who are negative for HBsAg and anti-HBs should receive the hepatitis B vaccination to prevent HBV infection and its complications. 1

Primary Vaccination Schedule

• Standard schedule: Three doses administered intramuscularly at 0,1, and 6 months 1
• For infants: Birth dose (within 24 hours) followed by doses at 6,10, and 14 weeks (given alongside DPT and OPV) 2
• The birth dose is particularly critical for preventing perinatal transmission and should be prioritized for all institutional deliveries 3

High-Priority Groups for Vaccination

1. Newborns and infants:

   • All newborns of HBV-infected mothers should receive HBIG and hepatitis B vaccine at delivery 1
   • Complete the recommended vaccination series regardless of maternal status 2

2. Healthcare workers:

   • All unvaccinated healthcare workers should be vaccinated before their first contact with blood 1
   • Despite high risk, approximately 28% of healthcare workers in India remain unvaccinated 4

3. Other high-risk groups:

   • Household and sexual contacts of HBsAg-positive individuals 1
   • Hemodialysis patients 1
   • Recipients of certain blood products (especially clotting-factor concentrates) 1
   • Clients and staff of institutions for the developmentally disabled 1
   • International travelers to high-endemic areas 1
   • Injecting drug users 1
   • Sexually active individuals with multiple partners 1

Post-Vaccination Testing

Post-vaccination testing for anti-HBs is recommended for:

• Infants born to HBsAg-positive mothers (test at 9-15 months of age) 1
• Healthcare workers (test 1-2 months after completing vaccination) 1
• Dialysis patients (test annually) 1
• Immunocompromised individuals 1
• Sexual partners of HBV carriers 1

Booster Doses

• Generally not required for immunocompetent individuals, as protection persists despite declining antibody levels 1
• Recommended for dialysis patients if annual testing shows anti-HBs <10 mIU/mL 1
• Consider a booster dose for healthcare workers 10 years after primary vaccination, as anti-HBs titers decline significantly over time 4

Post-Exposure Prophylaxis

For unvaccinated individuals exposed to HBV:

• Administer HBIG (0.06 mL/kg) and hepatitis B vaccine as soon as possible 1
• Preferably within 24 hours of exposure 1
• If delayed, postexposure prophylaxis should be initiated within 7 days for percutaneous exposure or within 14 days for sexual exposure 1

Additional Preventive Measures

1. Hepatitis A vaccination:

   • Recommended for all HBV carriers who are negative for anti-HAV 1
   • Coinfection with hepatitis A increases mortality risk by 5.6-29 fold in HBV carriers 1

2. Lifestyle modifications:

   • Abstinence or limited consumption of alcohol 1
   • Smoking cessation 1

Implementation Challenges in India

Several operational challenges have affected hepatitis B vaccine coverage in India:

• Poor stock management leading to "stock outs" at various levels 5
• Incomplete recording and reporting systems 5
• Fear of vaccine wastage with 10-dose vials 5
• Insufficient training and knowledge among healthcare workers 5
• Lack of coordination between different levels of healthcare system 5

Despite these challenges, India has made progress with hepatitis B vaccination coverage reaching 86% for the third dose, though birth dose coverage remains lower at 45% 3. The government has set a target of 90% birth dose coverage by 2030 3.

Key Pitfalls to Avoid

• Delaying birth dose beyond 24 hours significantly reduces effectiveness in preventing perinatal transmission
• Neglecting to vaccinate household contacts of HBV carriers
• Failing to test for vaccine response in high-risk individuals
• Overlooking the need for hepatitis A vaccination in HBV carriers
• Inadequate education of healthcare workers about vaccination protocols

By addressing these challenges and following these recommendations, India can significantly reduce the burden of hepatitis B infection and its complications.