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BETTER NOT TO MISS HEPATITIS VACCINE AT BIRTH

Hepatitis vaccine at birth is usually the first vaccine a newborn baby receives routinely after delivery. By saying ‘Hepatitis vaccine’ here we are referring to ‘Hepatitis B vaccine’. It is that vaccine which is made available close to labour room. Health care professionals try to administer this vaccine to a baby, as soon as possible following delivery. 

Why is Hepatitis B vaccine given ? What is the importance of Hepatitis vaccine at birth? We will find out answers to all such queries related to this vaccine, which keeps parents baffled.

What is “Hepatitis” ?

In Ancient Greek the word “hepar” implies “liver”. And the word “-itis” means inflammation ( soreness ). So, to put simply “hepatitis” is soreness of liver. Here the liver will become reddish, swollen and painful. 

What causes hepatitis ?

Hepatitis can be ascribed to numerous factors. These are listed below.

  1. Toxins – For instance exposure to toxic chemicals at workplace induce inflammation in liver.
  2. Drugs / Medicine – Few medicines if taken in higher doses incite hepatitis e.g anti – seizure medication, anti-tuberculosis medication, painkillers, antidepressants, immunosuppressants, anticancer medications etc. 
  3. Infection – There can be viral/ bacterial/ fungal/ parasitic infection etc, which may lead to liver inflammation or soreness.
  4. Alcohol – Taking alcohol beyond certain amount instigates hepatitis too.
  5. Non alcoholic Fatty liver disease – When fat builds up inside liver, it hampers normal function of liver, as in case of diabetes, obesity etc. This is again one of the causes of hepatitis.
  6. Metabolic disease – It is condition where a child has some kind of defective metabolism. Hence gradually there is accumulation of undesirable metabolic byproducts in liver. These sets off hepatitis. 
  7. Auto immune condition – Here a person’s own immune system attacks liver causing damage.
  8. Vascular cause – What attributes to liver ailment lies in abnormity of blood flow to liver or in blood vessel inside liver.

What are symptoms of Hepatitis?

hepatitis-b-symptoms- and-hepatitis-vaccine

Typical symptoms that transpires because of hepatitis are noted below.

  • Fever 
  • Jaundice ( yellow coloured skin and eyes )
  • Nausea, Vomiting 
  • Pain abdomen, predominantly right-upper part of abdomen where liver is located. 
  • Fatigue and weakness 
  • Loss of appetite 
  • Dark yellow urine 

What is viral hepatitis? How many types of viral Hepatitis do exist?

An infection can bring about hepatitis as well. Widely known causes in this category are viral infections. Some viruses have selective affinity for liver cells. They have specific receptors through which they attach to liver cell membrane and invade inside causing Hepatitis. 

  • Hepatitis viruses are of 7 types. Hepatitis A, B, C, D, E, F, G. These viruses differ in their gene structure. First 5 types from A to E are fairly common. 
  • Hepatitis F is a mutant variant of Hepatitis B. So it is just a sub-type of Hepatitis B virus and not some distinct organism. Given that, it is also called hypothetical hepatitis virus.

As of now vaccine for Hepatitis A and Hepatitis B are available. These are routinely used for kids. And also can be used for adults. 

What is hepatitis B virus infection ?

Hepatitis B is a virus that incurs serious liver disease. Many times it persists as a chronic infection and lasts for months together. This chronic infection occurs especially in infants and children. 

Chances of complications and death rate is high in Hepatitis B. It is an intractable disease. Hence it is difficult to cure. But prevention of Hepatitis B is easy, in the form of vaccine. And ideal way to achieve it is, by giving hepstitis vaccine at birth. 

How does Hepatitis B virus transmit to a person ?

Hepatitis B is highly infectious. This virus transmits through blood or genital fluid or through other body secretions. It is transfers from one person to another by following ways. 

  1. Blood transfusions from infected person 
  2. Sharing infected needle 
  3. Sexual transmission
  4. Perinatal transmission ( mother to baby transmission during delivery ) 
  5. Sharing personal objects like body shave, razor, toothbrush etc. 
  6. Getting tattoo, piercing etc.

Important note : 

Transmission through blood or sexual contact or through sharp objects is termed as horizontal transmission. Whereas transmission from mother to child is called vertical transmission. 

Why Hepatitis B is so significant ?

  • WHO says that, close to 296 million people worldwide, are living with chronic hepatitis B infection, as per 2019 data. Just imagine the load of virus in community.
  • But irony is about 80% of chronic hepatitis B infected people are not aware of their infection. As majority of them have vague symptoms like fatigue, body pain etc. 

What is most alarming is that Hepatitis B is 100 times more infectious than HIV infection. Can you believe that even as less as 0.001 ml of blood can even transmit Hepatitis B! This amount of blood is visibly negligible. That is why Hepatitis B can be transmitted by even sharing toothbrush, comb etc. 

Why Hepatitis B is considered deadly? What are its outcome ?

In developing countries, hepatitis B is the second most leading cause of mortality ( death ) due to an infectious disease. Tuberculosis being the first. 

Symptoms of hepatitis B – These are fever, rash, body pain, weakness, tummy pain etc. As symptoms of hepatitis B are vague, it remains under the radar. Patient overlooks these symptoms initially. On later stage, hepatitis B manifests as jaundice ( yellowish discolouration of skin and eye ) and liver dysfunction too. 

There are 2 types of hepatitis B infections as stated below.

  1. Acute hepatitis B – When duration of hepatitis B infection is less than 6 months. 
  2. Chronic hepatitis B – When duration of hepatitis B infection is more than 6 months.

Acute hepatitis B -

When immunity of a person is strong, it strives against the virus and clears it out. So the infection here is acute.

Chronic hepatitis B -

When a person’s immunity fails to block hepatitis B virus, it remains as chronic infection. Infants are more prone to develop chronic hepatitis B infection. Younger the age, greater the risk of chronic infection. 

 

Chronic carrier :

It may happen that a person carries hepatitis B infection inside yet will not develop any symptom. But this person will be repeatedly shedding the virus and spreading to others. The person might not be aware of same. This person is called chronic carrier of hepatitis. 

Deadly outcomes of hepatitis B infection ; complications :

Out of all hepatitis virus known so far, Hepatitis B is the deadliest. It can develop following complications. 

1.Fulminant hepatitis:

It is a condition where liver fails to function due to massive destruction of liver tissue. It develops within a very short span of time like days to weeks. It is a potentially fatal condition

2.Liver cirrhosis:

This is a complication where scar tissue replaces normal liver tissue. Consequently liver function deteriorates gradually as disease progresses. 

3.Liver cancer:

Chronic Hepatitis B infection can lead to liver cancer in long run. It is a grave condition

These dreadful complications make Hepatitis B the most severe Hepatitis virus. 

Why hepatitis vaccine at birth is so important?

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Most common and most important mode of transmission of Hepatitis B virus in endemic areas like Sub-Saharan Africa and South east Asia is ‘perinatal transmission’. Here virus passes on from mother to baby during pregnancy, or during process of labour or after delivery. This is also called ‘vertical transmission’ as discussed previously. 

When a baby gets infected through perinatal transmission, it usually develop into chronic hepatitis, cirrhosis of liver or even liver cancer. High chances are also there that this baby may turn into a hepatitis carrier, and disseminate the virus in community. 

That is the reason why hepatitis B vaccination is universally given to all babies at time of birth, as early as possible. This is known designated as “birth-dose”. It should be given by 24 hour of life at maximum. 

Maternal screening: All mothers should be screened for Hepatitis B infection. Reason being 80% of infected people don’t know that they are carrying infections. So, it is customary to test blood sample of pregnant woman for HBsAg i.e. Hepatitis B surface Antigen. 

But the catch here is, there is a certain timespan in an infected person’s life known as “window period” where HBsAg test is negative. But still the person has virus. 

Hence HBsAg screening is not 100% effective to detect all Hepatitis B infected mothers. That is why Hepatitis vaccine at birth is made mandatory except if weight of a baby is less than 2 kg or baby is not medically stable. 

 

What to do if baby is preterm weighing <2kg or medically unstable?

  • As per CDC, if baby is preterm weighing less than 2 kg or unstable, then wait till it grows up > or = 1 month of age and also is medically stable. Afterwards start the 3 dose series of Hepatitis B vaccines. 
  • But AAP ( American Academy of Paediatrics ) proposes a weight-based policy. As per it, these <2kg, preterm should be given hepatitis B vaccine once it attains at least 2 kg weight and is medically stable. 

But what if baby is preterm < 2kg, but mother is HBsAg positive?

In this case,  when mother is HBsAg positive, baby must be given hepatitis B vaccine irrespective of body weight and within 12 hour of life. 

But this vaccine jab in <2kg baby, is not counted as part of vaccination series. It is because immunity generated in these babies is not reliable. Hereby the vaccination series actually is counted after 1 month of age or after baby attains weight of 2 kg. 

What is ACIP and CDC guideline for birth dose of hepatitis b vaccine?

ACIP stands for Advisory Committee on Immunisation Practices. ACIP is the one which sets guideline for immunisation, which is acted upon worldwide. It has also set hepatitis B vaccine guideline for babies.

  • All babies need to receive a shot of Hepatitis B vaccine at time of birth, within 24 hours of life.
  • If mother is a known case of Hepatitis B, then baby must be immunised with Hepatitis B vaccine within 12 hours of life. Plus it ought to be given Hepatitis B immunoglobulin during within 12 hours of life. 
  • Both vaccine and immunoglobulin are injected at mid thigh, into muscle, but on two different sites. For instance if vaccine is given on one thigh then immunoglobulin should be given in opposite thigh. 

Conclusion

AAP and WHO ( World Health Organisation ) recommends hepatitis B vaccine to all infants. Early Immunization with hepatitis vaccine at birth works like a “safety net” to intercept transmission of hepatitis B from mother to baby, even if mother’s diagnosis is missed. 

I hope this post covers those untouched yet relevant sub-topics related to birth dose of Hepatitis B vaccine. Share this blog to maximum with parents and help them find out ‘when’, ‘how’ and ‘why’ of birth dose. 

Caution

All the informations provided here are for educational and awareness purpose only. Kindly do not use these as alternative to medical consultation.

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