Hepatitis B Immunoglobulin

In India, 1-4% of individuals are chronic carriers of Hepatitis B Virus (HBV). Infection with HBV may occur perinatally (vertical transmission), during early childhood (the so-called horizontal spread), through sexual contact or nosocomially. It should be noted that in our country horizontal route (e.g. child to child) route and the vertical route (i.e. mother to child) are the major routes of transmission of hepatitis B. The risk of infection in a child born to a Hepatitis B positive mother ranges from 10-85% depending on the mother's HBeAg status.

Younger the age of acquisition of HBV infection, higher the chances of becoming a chronic carrier. It is believed that as many as 90% of those who are infected at birth go on to become chronic carriers and up to 25% of chronic carriers will die of chronic liver disease as adults. Infection with HBV is one of the most important causes of chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma. These outcomes are all preventable by early childhood immunization. It is for this reason that the World Health Organization has recommended universal Hepatitis Bvaccination.

Vaccine

The plasma derived Hep B vaccine is no longer available. The currently available vaccine containing the surface antigen of Hepatitis B is produced by recombinant technology in yeast and adjuvanted with aluminium salts and preserved with thiomersol (thiomersol free vaccines is also available, Revac-Bmcf). Hep B vaccine is available as single and multidose vials and should be stored at 2 to 8° C. The vaccine should not be frozen; frozen vaccine should be discarded. The dose in children and adolescents (aged less than 18 years) is 0.5 ml/ 10 ug and in those 18 years and older is 1 ml/20 ug. It should be injected intramuscularly in the deltoid/anterolateral thigh. Gluteal injections should be avoided due to low immuno-genicity. The vaccine is extremely safe and well tolerated. The classical schedule is 0, 1 and 6 months. The vaccine is highly immunogenic and seroconversion rates are greater than 90% after a three dose schedule. Seroconversion rates are lower in the elderly, the immunocompromised and those with chronic renal failure. Four doses at 0, 1, 2 and 12 months of double dose may be given in these patients. Routine testing for anti HBsAg levels 1 month after completion of the immunization schedule is recommended in children born to HBsAg positive mothers, health care workers and those with comorbidities. Antibody titers greater than 10 mIU/ml signify a response and are considered protective. Non responders should be tested for Hepatitis B carrier status. If found to be negative the same three dose schedule

should be repeated. 50% of non responders may respond to the second series; the rest are permanently susceptible. Routine boosters are not needed in healthy children and adults. Studies have shown that individuals who had responded to the vaccination series and had levels of 10 mIU/ml after vaccination are protected against hepatitis B disease for life even if the levels drop to below protective levels or are undetectable later. This is due to immune memory. In the immunocompromised and those with co morbidities such as chronic renal disease, levels should be checked periodically and booster vaccination given whenever levels drop to below protective levels.

Hepatitis B Immunoglobulin (HBIG)

HBIG provides passive immunity and is indicated along with Hep B vaccine in management of perinatal/occupational/sexual exposures to Hepatitis B in susceptible individuals. The dose of HBIG in adults is 0.06 ml/kg and in neonates/infants 0.5 ml. HBIG should be stored at 2 to 8° C and should not be frozen. HBIG provides temporary protection lasting 3-6 months. HBIG should never be given intravenously. HBIG is also used alone following exposure to Hepatitis B in patients who are non responders to Hepatitis B vaccination (genetic reasons/ immunocompromised status). In this situation two doses of HBIG 1 month apart are indicated.

Recommendations for Use

The hepatitis B vaccines are of public health importance. The Government of India has initiated hepatitis B vaccination in EPI since June 2002 with expansion in a phased manner.

For office practice, the IAPCOI recommends offering hepatitis B vaccine to all children who can afford the vaccine (Category 2). Hep B vaccine may be given in any of the following schedules:

 a. Birth, 1 and 6 months

 b. Birth, 6 and 14 weeks

 c. 6, 10 and 14 weeks

Immunologically 0-1-6 months schedule of hepatitis B immunization has been most widely used and proven to be ideal with high antibody titers at the end of the vaccination. However Hep B vaccine is a T-cell dependent vaccine and the titers at the end of immunization schedule may not be important so far as it is well above the protective level. There would occur anamnestic response with the titers going up, should there occur contact with the virus again in future. Also now that Hep B vaccination is integrated into the existing immunization program (EPI) in India, due to operational issues at a national level one has to piggy back on the available contacts for routine immunization, i.e. DTP which is given at 6, 10 and 14 weeks of age. At the same time birth dose has to be given to cover for the vertical route. Hence IAPCOI recommends 0-6-14 weeks schedule for public health. In case birth dose has been missed, 6-10-14 weeks schedule can be followed. In office practice, one can still use 0 - 4/6 weeks - 6 months schedule. As of now, from the data available, none of the above schedules needs a booster. Catch up vaccination with Hep B vaccine as a 0,1, 6 schedule should be offered to all children/adolescents who have not been previously vaccinated with Hep B vaccine. This is to address problems related to horizontal mode of transmission of the virus. Prevaccination screening with anti HBsAg antibody is not cost effective and is not recommended. Catch up vaccination is particularly important for contacts of HBsAg positive patient. Prevaccination screening for HBsAg should be done in these contacts.

All available brands of Hepatitis B vaccine are equally safe and effective and any may be used. Interchange of brands is permitted but not routinely recommended. Combination vaccines containing Hep B are discussed separately.

Vaccination Chart for Children In India

Vaccination Schedule for children in India

 

Tags: Vaccines,Hepatitis A Vaccine ,MMR Vaccine, Typhoid Vaccine,Hepatitis B Vaccine,Yellow Fever Vaccine

Yellow fever @Travel

                                   Yellow fever is a disease caused by a virus of  flaviviridae group and  it is spread through mosquitoes in areas where the disease has been reported. Generally, regions in the South America as well as Africa is said to have reported cases of yellow fever whereas in the US, the last recorded epidemic was in 1905. When seeing the travelers, the disease can be comparably rare among the other diseases, but many countries has their own guidelines governing the use of Yellow fever vaccinations and thus would require travelers to obtain these vaccines if they plan to travel to these countries. Generally, the people who are living in South America and Africa are selected to be vaccinated for Yellow Fever.

Yellow fever is a disease that can be self-limiting and often mild whereas in its extreme instances, it can develop in to a life threatening disease with hemorrhagic episodes. The disease can be diagnosed based on the clinical findings, recent history of traveling to risk areas as well as through laboratory diagnosis. But, given the potential problems that it might give as well as the enormity of its spread when the vaccine was not available, authorities does not take the vital to vaccinate very lightly. Therefore, there are designated and approved vaccine centers that give the yellow fever vaccine and the local health authorities or else the CDC will be able to guide someone to the closest possible vaccine center

The vaccine that is being used for yellow fever is a live vaccine, meaning the constituents of the vaccine is the live organism but is able to launch an attack only to a level which makes the body produce the necessary antibodies. Thus, the protection given by this vaccine will last for about 10 years and following 10 years another booster dose needs to be given.The criteria to give the vaccine takes into consideration the age of the person as well as the presence of other conditions that may disrupt and generate side effects from the vaccine itself. Therefore, the vaccine is not usually given to infants below 6 months of age as well as in the following conditions.

• Patients who are having immune-compromised states such as symptomatic HIV, bone marrow cancers
• Use of drugs which alters the immune mechanism
• Acute infections
• Pregnancy

as well as allergies to eggs or any of the constituents of the vaccine.

Once the vaccine is given, a small percentage of people can develop mild symptoms such as pain, swelling, headache and a mild fever. But, life threatening allergic reactions is very rare.

In case you need more information, visiting the IHC Website 

http://internationalhealthclinic.co.in/yellowfevervaccination.htm

Reference:wikipedia

WELCOME TO INTERNATIONAL HEALTH CLINICS Pvt Ltd

International Health Clinic is a young and ambitious organization established in the year 2003 sister concern BHARAT VACCINES Hyderabad. The motto of our organization is to provide formerly established vaccines in the market at low cost, create awareness and educate people about the need of vaccines, specially in rural areas. We stay committed to innovation through most productive research and development program by studying the conditions that causes diseases which can be prevented. International Health Clinic focus our research on conditions that affect millions of people around the world – diseases like SWINE FLU, TYPHOID, YELLOW FEVER, HEPATITIS B, BRAIN FEVER. Alongside, Various Vaccines that we provide are Yellow FeverVaccination, Typhoid Vaccination, MMR Vaccination, Meningitis Vaccination, Hepatitis A - Vaccination, Hepatitis B - Vaccination and others. We also extend our services to international travelers, who travel exclusively to countries like US, UK, & all African countries etc.