Hepatitis B vaccination- CHEYYAR

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Introduction of Hepatitis B vaccination Programme : 

Introduction of Hepatitis B vaccination Programme

Hepatitis B : 

Hepatitis B In 1991, the World Health Organization (WHO) called for all children to receive the hepatitis B vaccine, and 116 countries have added this vaccine to their routine immunization programmes. However, the children in the poorest countries, who need the vaccine the most, have not been receiving it because their governments cannot afford it. Fortunately, hepatitis B vaccine is now available to us under Routine Immunisation.

Hepatitis B : 

Hepatitis B Hepatitis B is one of the major diseases of mankind and is a serious global public health problem. It is preventable with safe and effective vaccines that have been available since 1982. Although the vaccine will not cure chronic hepatitis, it is 95% effective in preventing chronic infections from developing, and is the first vaccine against a major human cancer.

WHAT IS HEPATITIS?: 

WHAT IS HEPATITIS? It can take several months to a year to feel fit again. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a Hepatitis vaccine is recommended.

How is Hepatitis B virus spreads? : 

How is Hepatitis B virus spreads? Hepatitis B virus is spread through contact with the blood and body fluid of an infected person. A person can get infected in several ways, such as: During birth when the virus passes from an infected mother to her baby By having sex with an infected person By injecting illegal drugs By being stuck with a used needle on the job By sharing personal items, such as razor or toothbrush with an infected person.

WHO GETS HEPATITIS B?: 

WHO GETS HEPATITIS B? Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.

Hepatitis B is a serious disease : 

Hepatitis B is a serious disease It can also cause long-term (Chronic) illness that leads to Lever damage Liver cancer Death

Hepatitis B is a serious disease : 

Hepatitis B is a serious disease The hepatitis B virus can cause short-term (acute) illness that leads to Loss of appetite Diarrhea and Vomiting Tiredness Jaundice Pain in muscles, joints, and stomach

Hepatitis B: 

Hepatitis B Acute Infection Mostly mild like flu 1 in 4 get worse with jaundice 1 in 200 die - fulminant Hepatitis Chronic Infection 1 in 10 acute infection leads to chronic Infection Chronic carriers may have no symptoms but can infect others

Hepatitis B : 

Hepatitis B HBV virus is NOT spread by contaminated food or water and can not be spread casually in the work place

Remember: 

Remember Chances of Hepatitis B Disease transmission is 100 times more than HIV / AIDS with same exposure

Hepatitis B: 

Hepatitis B Younger the child more chances of becoming carriers The latency period for disease to manifest in carriers could be 20- 60 years peak at 25-40 year

Hepatitis B: 

Hepatitis B The disease burden is significant and with high morbidity. The chronic disease manifests during mid life which are the most productive years of life ( 25-45) The financial burden and productivity losses are very significant

Slide 14: 

Section of liver damaged by HBV. Note the enlarged cells and blistering of the capsular surface."

"Section of liver damaged by HBV. Note the enlarged cells and blistering of the capsular surface." : 

"Section of liver damaged by HBV. Note the enlarged cells and blistering of the capsular surface."

HOW SAFE AND EFFECTIVE IS THE VACCINE?: 

HOW SAFE AND EFFECTIVE IS THE VACCINE? Hepatitis B vaccine has an outstanding record of safety and effectiveness. Studies have shown that the vaccine is 95% effective in preventing children and adults from developing chronic infection if they have not yet been infected. Most common side effects are: Soreness at injection site (3-9%) Fatigue, headache, irritability (8-18%) Fever higher than 37.7°C (0-8%) Allergic reactions rare (1 in 6,00,000)

Hepatitis B Vaccine: 

Hepatitis B Vaccine Vaccine administration Dose - 0.5 ml containing 10 ug of the vaccine Route - intra muscular Site - Antero-lateral aspect of thigh in infants Can be safely given with other vaccines DPT, OPV, BCG, Measles, Hib ( at different sites) Available as 10-dose vial of liquid vaccine in the programme Combination vaccines such as Hep B with DPT and Hep B + DPT + Hib are safe to be given

Hepatitis B Vaccine schedule: 

Hepatitis B Vaccine schedule At Birth ( within 72 hours or 15days ), (for Institutional deliveries) 6 , 14 weeks 2. 6, 10, 14 weeks (with DPT) Though both the schedules provide effective protection, 1 st schedule is most preferable for prevention perinatal infection

Preventing perinatal infection: 

Preventing perinatal infection Vaccinating new borns within 72 hours of their birth must be the main objective while implementing Hepatitis –B programme. This opportunity must be made uniformly available to all new born babies delivered at hospital for preventing perinatal infection.

Action Plan for HEPATITIS – B Vaccination : 

Action Plan for HEPATITIS – B Vaccination List out the following Health Facilities Government General Hospitals Medical College Hospitals Government Taluk Hospitals Post Partum Centers PHCs HSCs Private Hospitals

Hep.B vaccine to babies of less than 72 hours: 

Hep.B vaccine to babies of less than 72 hours Monthly deliveries to be analysed separately for hospital / institution / phcs / hscs / domicillary / private hospitals. Possibility of logistic arrangements like vaccine availability, AD syringes etc. at the place where delivery is taken place. Sensitization of all staff at the above health facilities regarding the importance of vaccination within 72hrs to new borns.

Hep.B vaccine to babies of less than 72 hours: 

Hep.B vaccine to babies of less than 72 hours Acceptance of the parents to have vaccination to their babies before 72hrs. Committed staff at the hospital/institution to give Hep.B Vaccine availability at the hospital store itself. Time / day required to bring vaccine to the hospital / institution where delivery taken place.

HEPATITIS – B Vaccination : 

HEPATITIS – B Vaccination S.No Institution Number of Deliveries in the past 6 months Average Delivery per month 1 Government General Hospital 2 Medical College Hospitals 3 Government Taluk Hospitals 4 Post Partum Centers 5 PHCs 6 Hospitals run by Non profitable organisation

HEPATITIS – B Vaccination: 

HEPATITIS – B Vaccination S.No Institution Vaccine Storage Available (Yes/ No) If no storage Whether Hep-B Vaccine can be given immediately on call Quantity required per month 1 Government General Hospitals 2 Medical College Hospitals 3 Government Taluk Hospitals 4 Post Partum Centers 5 PHCs 6 Hospitals run by Non profitable organisation

Hepatitis B Vaccine - Storage: 

Hepatitis B Vaccine - Storage COLD CHAIN The vaccine is to be stored and transported at +2 to +8 C It freezes at Minus 0.5 C hence extra caution to be taken to avoid freezing

Vaccine storage capacity: 

Vaccine storage capacity For estimation purposes, vaccine storage capacity of any cold chain equipment is considered 300 doses of mixed vaccine per litre. Vaccine carrier- 1.75 litre Cold box - 5 litre with recommended no. of IP (21-24 IP), 20/22 litre ( 50-52 IP) ILR ( MK-140/144 ) – 85 litre ILR ( MK – 300/304 )- 200 litre DF ( SB 140/144 )- 120 litre DF ( SB 300/304 )- 240 litre

IEC & Social Mobilization: 

IEC & Social Mobilization State specific IEC material to be used Posters Brochures Handouts Mass media (Print, AIR, Television) Social mobilizers – AWW, Link Workers, etc.

Sensitization Meetings/ Trainings: 

Sensitization Meetings/ Trainings Sensitization of MOs on hepatitis B vaccination introduction. ANMs VHNs / CHNs / SHNs sensitization during weekly/monthly meetings at PHCs Training on Hepatitis B as part of the immunization training to health workers

Supply of AD syringes: 

Supply of AD syringes AD syringes are supplied to district stores at tri monthly interval based on the beneficiary load of the district. Guidelines were given to redistribute the AD syringes to PHCs / Hospitals as per their requirement. Care should be taken to distribute the AD syringes as per actual requirement with certain quantity of buffer stock to all PHCs / Hospitals only for Immunisation purpose.

Supply of AD syringes: 

Supply of AD syringes In some districts, it is found that AD syringes are not made available to Hospitals where immunisation is taking place. AD syringes should be supplied to those Hospitals after obtaining proper indent based on immunisation load.

Inclusion of JE Vaccination under Routine Immunisation in selected districts: 

Inclusion of JE Vaccination under Routine Immunisation in selected districts One dose of JE vaccination is to be started along with DPT/ OPV booster dose in 16 to 24 months children in the following HUDs. 1. Cuddalore 2. Villupuram 3. Kallachurchi 4. Virdhunagar 5. Sivakasi . as a cohart following the recently conducted Mass JE vaccination programme in these programme districts. This will be regularly done along with Routine Immunisation.

Hep-B - A Public Health Problem: 

Hep-B - A Public Health Problem Silent Killer Unable to correlate between Infection and mortality / morbidity because of long gap of 20 – 50 years Approximately 30% of world population of 2 billions have serological evidence of infection Of these 350 millions are chronically infected i.e., carriers Of the above one million die each year due to liver cirrhosis / cancer Hepatitis means infection of liver

Transmission of Hepatitis B: 

Transmission of Hepatitis B Mother to Baby at the time of birth Child to Child (cuts, bites, scratches) Unprotected sexual intercourse Blood transfusion of infected blood Unsterilised needles From body fluids – Blood, Semen, Vaginal secretions mainly Chances of Hepatitis B disease transmission is 100 times more than HIV/AIDS with same exposure

Age of Infection Vs Carrier Status: 

Age of Infection Vs Carrier Status Most people become infected during childhood 90% of infants 30 – 40% of children (1 to 7 years) 5 – 10% of Adults and Children above 7 years will become carriers after infection with Hepatitis B virus 25% of children infected will die of liver cancer / cirrhosis

Risk by Age: 

Risk by Age Type If Infected Then carrier status And Cirrhosis / Cancer Infant 100 90%= 90 25% of 90 = 23 Child 100 30%= 30 25% of 30 = 8 Adult 100 7% = 7 25% of 7 = 2 Younger the child, more the chances of becoming carriers The latency period for disease to manifest in carriers could be 20 – 60 years peak at 25 – 40 years

Hepatitis B vaccine: 

Hepatitis B vaccine Prevent disease and thus the carrier state in almost all individuals Manufactured using DNA Recombinant Technology and no live component Schedule GOI Recommendations: Birth, 6, 14 weeks (for Institutional Deliveries) 6, 10, 14 weeks with DPT Both the schedule provide effective protection

Hepatitis B vaccine: 

0.5 ml IM Antero lateral aspect by thigh in infants Can be safely given with other vaccines DPT, OPV, BCG, Measles at different sites Available as 10 dose vial of liquid vaccine Safe vaccine Hepatitis B vaccine

Common side effects: 

Common side effects Soreness at injection site 3-9% Fatigue, headache, irritability 8-18% Fever 0-8% Allergic reactions are rare (1 in 6,00,000)

Cold Chain: 

Cold Chain To be stored and transported at +2 to +8° C It freezes at minus 0.5° C and hence extra caution to be taken to avoid freezing Not to be kept at the bottom of ILR More freeze sensitive vaccine

Vaccinate the Infants at the earliest: 

Vaccinate the Infants at the earliest Create awareness among the staff of Institutions conducting deliveries to immunise the child at the earliest, preferably in the first 24 hours. Regional meeting for medical officers of Govt. Hospitals and staff nurses to be held by DDHS for disseminating this message and practicing Records to be maintained at Institutions AD syringes must be provided by DDHS to all these Hospitals Training proposals for training these staff nurses (both in Govt. and Pvt. Institutions) must be planned and proposals to be sent

Thank you: 

Thank you