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Introducing
Hepatitis B Vaccine in Universal Immunization Programme in India - A
Brief Scenario
Burden of Disease
Hepatitis
B is a major public health problem worldwide. Approximately 30 percent
of the world’s population, i.e. about 2 billion persons, have serological
evidence of current or past HBV infection. Of these, an estimated 350
million have chronic HBV infection and at least one million persons die
annually from HBV-related chronic liver disease, including cirrhosis and
liver cancer.
India
has intermediate endemicity of Hepatitis B, with
Hepatitis B surface antigen (HBsAg) prevalence
between 2% and 7% among populations studied. The prevalence does not
vary significantly by region in the country. The number of HBsAg carriers in India has been estimated to be
over 40 million (4 crore). It has been estimated that, in India of the
25 million infants born every year, over one million run the lifetime risk of
developing chronic HBV infection. Every year over 100,000 Indians die due to
illnesses related to HBV infection.
Introducing Hepatitis B Immunization as
part of UIP
The Hepatitis B Project was initiated in India in the year 2002 with
support of Global Fund for vaccines & Immunization (GAVI). An agreement
was signed by Govt. of India, Inter Agency Cooperation Committee (IAC) &
the GAVI for this project. The partners from IAC for this initiative
include W.H.O., UNICEF, USAID, PATH, World Bank, DIFID & European Commission.
In the first quarter of year 2003 the vaccination of
infants in the slums of 15 selected cities was initiated. In the last quarter
of the year 2003 it was expanded to cover all the infants of 33 selected
districts of the country. The list of project cities & districts is
stated under the link having the title - Frequently Asked Questions and
Answers.
The second phase of the project is planned to be initiated
under the new application submitted by the Govt. of India in Sept. 2004 to
the Global Alliance for Vaccines & Immunization (GAVI). In this phase of
the project the continuation & improving the vaccination coverage of
Hepatitis B & DPT vaccination is planned in the existing project area. In
addition to this the coverage of about 1.49 million non slum infants is also
planned in the project cities from year 2005 to ensure equity, improve
immunization coverage & also the epidemiological impact in the selected
geographical area. In this second phase of the project another important area
being covered by the Govt. of India is improving the Injection Safety. Under
this initiative steps are being taken to ensure the availability of AD
syringes in all the immunization sessions of the country by the end of year
2005.
Role of W.H.O.
All the members of the IAC have been contributing their
vision & support in planning & policy decisions related with the
project. The technical assistance for planning, trainings & monitoring of
the project is being provided by W.H.O. The specific activities assisted by
W.H.O. India office include developing Operations Guide for the Program, help
in preparation & review of training material, Training of Trainers &
conducting workshops of Program Managers along with other programme
partners such as PATH & UNICEF. The periodic feed back on analysis of the
immunization performance reports is being provided to the project cities
& districts & the system of procurement and distribution of Hepatitis
B vaccine & AD syringes is being made more effective by taking into
account the actual utilization and balance stock, with the technical
assistance being provided by the W.H.O. India office. Recently in August
2004, a Rapid Assessment of Hepatitis B Introduction in India has been completed by the WHO-SEARO
& India Office with the participation of experts from WHO,
PATH, UNICEF & Govt. of India.
The Training
Modules developed for Medical Officers & Vaccinators & further
technical details about introduction of Hepatitis B vaccine & AD syringes
in the country are available from separate links connected with this brief.
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