A large multicentre study in North India demonstrates that many newborns are protected during birth by natural antibodies to hepatitis-B thus Hep-B vaccination during childbirth isn’t important. The research, whose discoveries have been published in the Indian Journal of Pediatrics, was done to look at whether hepatitis-B vaccination during birth was crucial for India.
Hepatitis-B infection (HBV) can cause chronic hepatitis, liver cirrhosis and lead hepatocellular carcinoma (HCC) in susceptible people.
The research, which was supported by the Indian Council of Medical Research (ICMR), involved 2671 children from participating centers in Delhi, Rajasthan, Uttar Pradesh, Uttarakhand, and Gujarat of whom 880 were completely immunized starting at birth and 686 were completely immunized however without the birth dose.
This study had launched by ICMR to look at hepatitis-B infection rates in children vaccinated at birth compared to those vaccinated starting at a month and a half.
The study found that infection rate was similar even in those infants not given the birth dose thereby supporting the government’s pragmatic program.
The government’s pragmatic program lends the study to vaccinate babies born at home starting at a month and a half rather than during birth.
The study’s primary author and a pediatrician at St. Stephens Hospital in Delhi Jacob Puliyel say, “We discovered birth dosage was not required as infection rates were the same regardless of birth dose”.
The analysts also discovered high protective antibodies in children before vaccination indicating that missing the birth dose does not cause much problem.
Puliyel a member of the government’s technical advisory board on immunization says, “These natural antibodies may also be the reason behind why the hepatocellular carcinoma rate in India is low”.
The study support ICMR study which is led by Andhra Pradesh announced in 2014 also reported the presence of hepatitis-B antibodies in children before vaccination in North India.
The fact that a good number of unvaccinated children had high levels of antibody suggest it could be protecting some infants early in life when they are vulnerable to develop chronic hepatitis.
To hepatitis-B infection, most of the children are naturally immune because of passive transfer of antibodies from the mother.
India began vaccinating children against hepatitis-B in 2011. It is given during birth to babies born in hospitals. In any case, because many infants are delivered at home, outside of healthcare settings, the government introduced the pragmatic program schedule of HBV vaccination, wherein the vaccine is given starting at a month and a half to babies born outside such health-care settings.
However, mothers in highly immunized communities have lower hepatitis-B antibody levels as vaccine prompts lower antibody levels than natural infection and the antibody levels of vaccinated cohorts are never again supported by exposure to wild-type infection.
Puliyel says babies born to these mothers will correspondingly have lower levels of antibodies.
“Consequently, paradoxically, across the nation Hepatitis-B inoculation may decrease natural antibody transfer to infants and there is a possibility it might increase the incidence of HCC instead of reducing it.”
He cautions that more studies are needed to confirm this before changes in immunization practice can be suggested