Anu Mary, Alexander (2009) Evaluation of the Program for prevention of vertical transmission of Hepatitis B infection in Kaniyambadi Block and CHAD Hospital. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Hepatitis B infection which has been listed among the top ten leading causes of death Worldwide is one of the few vaccine preventable causes of a cancer. It is estimated That one in three persons worldwide show evidence of current or past infection with Hepatitis B. There are around 350 million chronic carriers of Hepatitis B infection of Which a fourth will progress to have either cirrhosis of the liver or hepatocellular Carcinoma. Although there are many approaches to prevent transmission of Hepatitis B infection, Hepatitis B vaccine is the most effective method for the same. The vaccine has an Efficacy of 95% when used as a pre-exposure prophylaxis. Perinatal transmission of Hepatitis B which is an important route of infection is Believed to be responsible for a third of adult chronic carriers in India. Prevention of Perinatal transmission of Hepatitis B is an effective method of reducing the prevalence Of chronic HBsAg carriers, in areas where a large proportion have acquired infection Through this route. Studies have shown that a combination of Hepatitis B Immunoglobulin and Hepatitis B vaccine is 92-100% effective in preventing perinatal Transmission of Hepatitis B from HBsAg positive mothers to their infants. However, In view of the high costs of Hepatitis B immunoglobulin, this strategy may not be Possible in resource poor countries like India. The Hepatitis B vaccine alone when Given soon after birth also has a remarkable efficacy ranging from 72%-100%, when Given as a post exposure prophylaxis to infants born to HBsAg positive mothers. AIM: To evaluate a program to prevent vertical transmission of Hepatitis B in Kaniyambadi Block and CHAD hospital Primary objective : To evaluate the effectiveness of the program in reducing the vertical transmission of Hepatitis B among children born to HBsAg positive mothers who received three doses Of the Hepatitis B vaccine commencing at birth. Secondary objectives : 1. To assess the effectiveness of the Hepatitis B immunization program in Providing the planned immunization schedule commencing at birth. 2. To determine seroprotection among children who received three doses of the Hepatitis B vaccine. 3. To determine the prevalence of HBsAg among children born to HBeAg positive Mothers, who received three doses of Hepatitis B vaccine commencing at birth. 73 CONCLUSIONS : The CHAD program for the prevention of vertical transmission of HBsAg was successful in screening 93% of the pregnancies in the service area, which was one rural block in Tamil Nadu. The prevalence of HBsAg positivity among the antenatal women in the service area was 1.25 % (95% CI: 1.05%-1.45%) which falls into the category of low endemicity according to the WHO. Evaluation of the program showed coverage of 70% for immunization with three doses of the Hepatitis B vaccine on schedule, commencing at birth. The program was able to administer birth dose to 77% of children born to HBsAg positive mothers in the service area and three doses of the vaccine to 94.8%. Presence of HBeAg in the mother was found to be significantly associated with immunization failure (RR of 5.8; 95% CI: 1.58-21.11). The seroprotection rate (anti HBs of at least 10 mIU/ml) of children between 6-24 months was 92.4%. The vaccine efficacy was found to be 68% which was similar to other studies. As the NNT was 8.6, this implied that 8.6 children would have to be immunized in order to prevent one case of vertical transmission. The NNS being 688, this was the number of women who would have to be screened in order to prevent one case of vertical transmission of HBsAg by a program of selective immunization. The cost of preventing one case of HBsAg infection among children born to HBsAg positive mothers was Rs. 22,188 by the selective immunization strategy and Rs. 20,640 by universal immunization. Considering the fact that many deliveries occur in lower level health facilities without a cold chain even in places where the rate of institutional deliveries may be high, universal immunization may not always be feasible and selective immunization may be a viable alternative.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prevention ; Vertical Transmission ; Hepatitis B Infection ; Kaniyambadi Block ; CHAD Hospital. |
| Subjects: | MEDICAL > Community Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 24 Jul 2017 06:14 |
| Last Modified: | 24 Jul 2017 06:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1273 |
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