Selective Versus Universal Hepatitis B Vaccination in India

Authors : Kale, Ashok; Phadke, Anant

Published Year: 2002

Paediatrics Today, Vol. 5(4), July 2002, pp. 199-207

This paper compares the cost–efficiency of Selective and Universal hepatitis-B vaccination of newborns in India. Part-I critically examines this comparison made by Aggarwal and Naik (the only such comparison in India). It argues that firstly Aggarwal-Naik have measured cost-efficacy in terms reduction in HBsAg-pool and not in terms of reduction in the highly infectious and highly pathogenic HBeAg pool. Secondly in their cost-calculations, they have made biased, unrealistic assumptions about cost of the Selective Vaccination programme, which renders their exercise invalid. Thirdly, the data they have used, itself shows that Selective Vaccination of newborns of HBsAg positive mothers would reduce the HBeAg pool by 40% by immunizing just about 4 % of the newborns; epidemiologically a very attractive option. Part-II compares the cost efficacy of Selective versus Universal hepatitis-B vaccination strategies in India. The Selective vaccination strategy that we propose consists of in year I, identifying all the HBsAg positive mothers through antenatal screening and vaccinating their newborns within 24 hours of birth. This would protect about 40% of the newborns from the risk of HBeAg positivity by vaccinating only the 3% of the newborns, and the programme would cost one fourth of the programme of Universal Vaccination of all the newborns. Logistically also it would be a far better strategy. From year II onwards, only the HBsAg positive primis would be detected and their newborns will be vaccinated, along with vaccinating subsequent newborns of the cohort of HBsAg positive mothers, identified in year I. This subsequent annual screening of only the primis would, without reducing its efficacy, reduce the annual cost of the Selective Vaccination Programme from year II onwards, to only 8% of the annual cost of Universal Vaccination. In our epidemiological and socioeconomic situation, eradication of hepatitis–B is neither warranted nor possible in the next 50 years even with Universal Vaccination. This fact strengthens the case for this highly Selective Vaccination strategy .

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