A study funded by Indian Council of Medical Research (ICMR) and published in the Indian Journal of Pediatrics was recently conducted by a group of pediatricians to examine if the birth dose of the hepatitis B vaccine is crucial for acquiring full immunity against hepatitis B infection.1
India first introduced the hepatitis B vaccine in 2006. Approximately 61 percent of Indian women give birth at home rather than in a healthcare facility, making it nearly impossible for healthcare providers to administer newborn vaccines. Given this reality, the Indian government’s policy is to give the hepatitis B vaccine at birth to the 39 percent of babies born in healthcare settings and to administer the first dose at six weeks for babies born at home.2
Hepatitis B is an infection of the liver caused by the hepatitis B virus. It can either be acute and self-resolving or chronic, possibly leading to liver cirrhosis.3 This virus spreads through contact with infected body fluids such as blood transfusions and unprotected sexual contact and can pass from mother to baby.1
Blood samples from 1- to 5-year old children from five states (Delhi, Rajasthan, Uttar Pradesh, Uttarakhand and Gujarat) were collected to measure antigen and antibodies of the hepatitis B virus. In this sample, 880 children were fully vaccinated with the hepatitis B vaccine starting at birth, 686 were fully vaccinated but without the birth dose of the hepatitis B vaccine and 844 were unvaccinated.4
The findings showed that children who were fully vaccinated with or without birth dose of the hepatitis B vaccine had similar levels of protection against the infection.1 The study’s lead author Jacob Puliyel, MD, who is a pediatrician at St. Stephens Hospital in Delhi stated:
We found birth dose was not needed as infection rates were the same regardless of birth dose. However, if the mother is a hepatitis B carrier especially if she is e-antigen positive, the baby must be vaccinated at birth.1
Dr. Puliyel added:
Studies must be replicable before they can be accepted. We now have two studies, one from South India and this one from North India showing that many babies have acquired passive immunity that may be protecting them soon after birth when they are most vulnerable to develop chronic hepatitis. Further, studies may be done to confirm these findings.1
The results of the study support the Indian government’s approach to vaccinate babies born at home at six weeks instead of at birth.
In the United States, since 1991 the Centers for Disease Control and Prevention (CDC) has recommended that all infants receive the hepatitis B vaccine on the first day of birth before leaving the newborn nursery.5 Women who give birth in U.S. hospitals and medical facilities are routinely screened for hepatitis B infection.
Although only babies born to hepatitis B infected mothers are at risk for hepatitis B infection at birth and have a 20 to 90 percent increased risk of becoming chronically infected with hepatitis B, every newborn is vaccinated whether the mother tests negative or positive.6 According to the CDC, this national policy was instituted to reduce the risk of a newborn contracting the disease from a mother who may not know she is infected with hepatitis B.5