Literature review for - Flourish Paediatrics

Hepatitis B Virus (HBV)
Hepatitis B is one of the most widespread global infections with an estimated 2 billion people
showing evidence of past infection and more than 350 million are chronic carriers (WHO
2009). Vaccination has been available since 1982 and over one billion doses of hepatitis B
vaccine have been used worldwide since then. In many countries where 8% to 15% of
children would have been chronically infected with HBV, vaccination has reduced the rate of
chronic infection to less than 1% among immunized children.
By the end of 2006, 164 countries had introduced programs to vaccinate infants against
hepatitis B. The WHO has set a goal that by 2010 all countries will have routine
immunization coverage at 90% nationally with at least 80% coverage in every district. China
has set hepatitis B prevention as a major public health goal (Zhou, Wu et al. 2009). Overall
more than 95% of Chinese infants are now vaccinated, although in some rural areas coverage
may be a little below this level. The rate in Australia is also approaching 100%.
The management of mothers with hepatitis B aims to reduce the possibility of infants
developing hepatitis. The WHO recommends that all infants receive hepatitis B vaccine as
part of routine childhood immunization. Where feasible, the first dose should be given within
48 hours of birth or as soon as possible thereafter. This will substantially reduce perinatal
transmission, and virtually eliminate any risk of transmission through breastfeeding or
breastmilk feeding. Immunization of infants will also prevent infection from all other modes
of HBV transmission.
Current Australian Recommendations are: (Department of Health and Ageing 2008)
“A birth dose of thiomersal-free monovalent hepatitis B vaccine, followed by doses given in
combination vaccines (such as DTPa-hepB, DTPa-hepB-IPV, DTPa-hepB-IPV-Hib or Hib
(PRP-OMP)-hepB) at 2, 4 and either 6 or 12 months, is recommended for all children.”
The rationale for the universal birth dose is not only to prevent vertical transmission from a
carrier mother (recognising that there may be errors or delays in maternal testing, reporting,
communication or appropriate response), but also to prevent horizontal transmission in the
first months of life from a carrier among household or other close contacts. The birth dose
should be given as soon as the baby is physiologically stable, and preferably within 24 hours
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