Discussions marquées : Hepatitis B

Promoting HEP B birth dose coverage

Dear viewers We wish to share the original article -- “Study on Hepatitis B Birth dose Vaccination Coverage, Promoting the same in a Private Rural Medical College”. Though Viral Hepatitis – a silent public health problem of “extraordinary scale” could not feature in MDG goals, got qualified to be observed as “World Hepatitis Day” since July 2010. On record analysis of vaccination data entered in the extended Immunogram of RHTC Sampaje with only ~17,500 population, 216 children below one year, inspired us to take up the study in a little larger scale covering 4 planning units with 1,19,837 population, cohort of 1508 children born between 01st April 2013 and 31st March 2014. Of this, 1075 (71.28%) were born in 96 private facilities who administered birth dose to 466 (43.3.5%) children and 433 (28.71%) were born in 41 Government facilities and HepB birth dose was administered to 380 (87.76%) live births. HepB birth dose was introduced in 2009 in Karnataka. After finding the gap, we made an effort to promote the same through simple doable measures in a rural Medical College; the coverage dramatically improved from 19% in April to 100% in July and high coverage is sustained till date. It was stated that “Raising birth dose coverage” is one of the major concerns.  Position paper on HepB vaccine also expressed that birth dose coverage is to be included as one of the performance indicators to review the performance in the regular review meeting for sustaining the achievement. Hence we thought of sharing the attached article with the viewers for further inputs.     best regards Holla and the team

Manoor Sub-Centre (SC) – beyond 2020: A template for replication:

Dear viewers Manoor is a SC of Community Health Centre (CHC) Kota of Udupi Taluk and district of Karnataka state. What the country wants to achieve by 2020 is already achieved and sustained. Udupi and the neighboring districts – Dakshinakannada, Kodagu, are all well performing districts. Only constraint is that 71.5% of birthing is occurring in the private sector including a pioneer private Medical College who deny / delay the administration of HepB birth dose vaccine and the coverage is 43.1%. The service providers from the Government have no access to timely vaccinate these newborns born in the private sector. Advocacy with the Medical College made no dent till this date. With personal efforts could get HepB birth dose vaccine to his child after 24 but before 48 hrs in his college. Following is the summary of data analysis of this SC with impression and recommendations: • Planning Unit : CHC Kota, SC : Manooru • Population : 6,180; CBR : 12.62 • Annual infants : 78; Annual Pregnant Women : 84 • ANM : Manda A Naik; Phone : 9731683226 • AWW : Shantha; ASHA : Jayanthi • Distance : 3 Km; AVD : ASHA • Transportation : Bus; Session Day/Date : 17th of every month Newborn Vaccination: 100% institutional delivery: 28.5% in Govt and 71. 5% in Private, Newborn Vaccination is 100% in Govt. Low and late birth dose HepB in private sector including Medical College. Zero OPV - 97.1%. BCG – 97.8%. HepB birth dose Primary vaccination is 100%. All completed 1st dose within 14 weeks All completed 3rd dose within 6 months; ~96% got subsequent dose within 6 weeks from the previous dose; All received DPT1Booster / OPV / Measles 2 between 518 & 622 days, completed before 21 months. Impression: Data analyzed using EXTENDED IMMUNOGRAM. Ø This Subcentre of Kota CHC has no population immunity gap. It has no backlog / dropout / left out. Ø It is operating routine immunization outreach session in “ALL TIME MISSION MODE”. Ø The exemplary work needs to be appreciated for replication and sustenance. The same in the form of PPT is attached. This is shared with ANM / LHV / MO / RCHO / DHO / DISTRICT MAGISTRATE of Udupi district for appreciating the dedicated work of the ANM/AWW/ASHA of Manoor SC. With regards Holla and the team

Strategic Advisory Group of Experts (SAGE) on Immunization October 2016 meeting report

Melanie Marti Publié dans :
The SAGE October 2016 meeting report has been published in the WHO Weekly Epidemiological Record. SAGE reviewed relevant data and evidence, advised and made recommendations on various complex and critical issues including: Global Vaccine Action Plan: 2016 mid-term review of progress and recommendations Maternal and neonatal tetanus elimination (MNTE) and broader tetanus prevention Measles and rubella elimination Hepatitis B vaccination Schedules and strategies for human papillomavirus (HPV) immunization Yellow fever Polio eradication The meeting report can be downloaded at http://apps.who.int/iris/bitstream/10665/251810/1/WER9148.pdf?ua=1

New "Vaccine" article: Hepatitis B vaccine stored outside the cold chain setting: a pilot study in rural Lao PDR

Great study on off-label use of HepB vaccine out of the cold chain and how this help raise HepB birth dose coverage by almost 30% without any safety or adverse reaction reported.It does feel that we really don’t make full use of VVMs!!!
Hepatitis B vaccine stored outside the cold chain setting: a pilot study in rural Lao PDRAmy R. Kolwaitea (CDC); Anonh Xeuatvongsa (MoH Lao PDR); Alejandro Ramirez-Gonzalez (WHO Lao PDR now in HQ); Kathleen Wannemuehler (CDC); Viengnakhone Vongxaye (MoH Lao PDR); Vansy Vilayvonee (MoH Lao PDR); Karen Hennessey (WHO WPRO now HQ); Minal Patel (CDC now WHO HQ)
BackgroundHepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic (Lao-PDR) to prevent perinatal hepatitis B virus transmission. HepB-BD, which is labelled for storage between 2 and 8 °C, is not available at all health facilities, because of some lack of functional cold chain; however, previous studies show that HepB-BD is stable if stored outside the cold chain (OCC). A pilot study was conducted in Lao-PDR to evaluate impact of OCC policy on HepB-BD coverage.
MethodsDuring the six month pilot, HepB-BD was stored OCC for up to 28 days in two intervention districts and stored in cold chain in two comparison districts. In the intervention districts, healthcare workers were educated about HepB-BD and OCC storage. A post-pilot survey compared HepB-BD coverage among children born during the pilot (aged 2–8 months) and children born 1 year before (aged 14–20 months).
FindingsIn the intervention districts, 388 children aged 2–8 months and 371 children aged 14–20 months were enrolled in the survey; in the comparison districts, 190 children aged 2–8 months and 184 children aged 14–20 months were enrolled. Compared with the pre-pilot cohort, a 27% median increase in HepB-BD (interquartile range [IQR] 58%, p < 0.0001) occurred in the pilot cohort in the intervention districts, compared with a 0% median change (IQR 25%, p = 0.03) in comparison districts. No adverse reactions were reported.
InterpretationOCC storage improved HepB-BD coverage with no increase in adverse reactions. Findings can guide Lao-PDR on implementation and scale-up options of OCC policy.

Hepatitis B guidance documents available in English and French

The following guidance documents are now available:

This document is now available in both English and French. The main purpose of this document is to evaluate published and grey literature on best practices for provision of hepatitis B vaccine to newborns. The document examines which practices improve coverage and describes facilitators and barriers to improving coverage of the birth dose.

This document is now available in both English and French. This document describes best practices for implementing hepatitis B serosurveys, including survey design, sampling, field methods, and data analysis.

Promoting Hepatitis B birth dose in private sector

The study area is a Health Sub-Centre in a Primary Health Centre of a coastal district of Karnataka state. This district has already achieved the Millennium Development Goals 4 & 5 of 2015 and the targets set for 2017 under RMNCH+A. But it is lagging behind in HepB birth dose. In this district, >65% deliveries are occurring in private institutions including Private Medical Colleges. Only a few are practicing administration of HepB birth dose. ANM, in her outreach session can administer zero OPV (within 2 weeks since birth) and BCG (within 4 weeks since birth) but not HepB birth dose as this needs to be administered within 24 hrs.

100% institutional delivery is a boon providing a golden opportunity for newborn vaccination. This can be one of the best gifts, social service to the newborn and an opportunity to honor child's right to health.

Study observations are shared for strengthening Newborn vaccination specially HepB birth dose.

Hepatitis spreading because of reuse of syringes

Around 12 million people in Pakistan are suffering from hepatitis B and C, with Balochistan topping the list followed by Punjab, Sindh and Khyber Pakhtunkhwa. Pakistan has the highest therapeutic use of injections worldwide and researchers in the country have found that the increasing incidence of hepatitis, especially hepatitis C, is directly related to the higher use of injections and reuse of syringes.

The research published two years ago was the first national population-based study on hepatitis.As per findings of the previous studies largely based on hospital and clinical data, 16 million people in the country were suffering from hepatitis B and C. Over 300 local and international papers have been published on the subject and most of them are based on hospital or clinical data. The hospital data usually shows a higher rate of disease prevalence. The study showed that 7.4 per cent (11.84 million) population in the country was suffering from hepatitis (hepatitis B 2.5pc) and (hepatitis C 4.9pc).The prevalence of hepatitis B was found to be: Balochistan (4.3pc), Sindh (2.5), Punjab (2.4pc) and Khyber Pakhtunkhwa (1.3pc).The prevalence of hepatitis C: Sindh (5pc), Punjab (6.7pc), Balochistan (1.5pc) and Khyber Pakhtunkhwa (1.1pc).

The high risk districts for hepatitis B: Musakhel (14.7pc), Khairpur (6.3pc), Ghotki (5.9pc), D.G. Khan (5.7pc), Islamabad (5.6pc) and Upper Dir (5pc).The high risk districts for hepatitis C: Vehari (13.1pc), Hafizabad (12.9pc), Ghotki (12.7pc), Hangu (6.4pc), Musakhel (5.3pc) and Jaffarabad (5.2pc).About 7,000 households were visited in the study and the average number of individuals found in each household was 6.7pc.

It wasn’t an easy task as to go to every district of the four provinces. People were tested on the spot and handed over the reports. The positive cases were referred to the nearest government health facility.The teams visited the areas faced no problems accessing people in militancy-hit areas, including that of Balochistan. “In fact, people were very supportive when they were informed about the survey’s objectives.

One major factor contributing to the spread of infectious diseases, especially hepatitis, was a high use of injections and reuse of syringes in Pakistan.The World Health Organisation allows 3.5 injections per person per year. However, the therapeutic use of injections in Pakistan is very high –13.6 injections per person per year.The higher use of injections makes a person vulnerable to infection. This vulnerability further increased with the reuse of syringes.

Other risk factors for hepatitis,included needles, drips,multi-dose injection vials, improperly sterilised invasive medical devices such as thermometers, tongue depressors and surgical and dental equipment, unscreened blood transfusions, communal shaving and unsafe sex.

Balochistan,had the highest (4.3pc) prevalence rate for hepatitis B which was almost double of the national figures (2.5pc). Though the incidence of hepatitis B was falling due to vaccination, hepatitis was still within the previous range. The breakdown of provinces showed higher incidence of hepatitis C in Sindh and Punjab.

More active vaccination against hepatitis B was required, especially in high prevalence districts of Balochistan.For that the government needs to take help from all organisations, all stake holders including security forces in campaigns advocating judicious use of injections should also be launched.


Cocktails safe or not?

Hi All,

After several years of working in Immunization related activities to help others, I find myself on the other side of the fence, with a 2 month old baby, in Senegal, trying to get her shots. She was born in the US, and we opted not do the HEP B at birth and figured to start at 2 months. We went to a fancy pharmacy in Saly, where they only had DTaP + PCV + Hib + Polio as a cocktail and didn't know anything about RV and then Hep B as a standalone.

I had in the past heard concerns about such cocktails (which may be rumour), but then came across this article India Serves Up Costly Cocktail of Vaccines and wondered if the claims regarding adverse reactions and deaths are true.

If we want to avoid cocktails, is it possible to do so still? Would there be any benefit to dividing immunizations up so that DTP/Polio/Hep B are on one schedule, and PCV/Rota are on another, and a month out of phase (for example)? Is Hib really necessary?

I'm sorry to post a question of such a personal nature on Technet, but the amount of information online regarding child immunization is overwhelming and riddled with contradictions. WHO and CDC policy are one thing but also developed as blanket approaches to maximize the overall benefit to populations (no?). I have the ability to take as as many trips as needed to the pediatrician, and can afford to buy vaccines separately - should I?

Many thanks,

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