Academic journal article Canadian Journal of Public Health

Measuring Hepatitis B Uptake in a New Universal Infant Program

Academic journal article Canadian Journal of Public Health

Measuring Hepatitis B Uptake in a New Universal Infant Program

Article excerpt


Background: Vancouver-Richmond Health Board has the highest reported rate of hepatitis B in Canada, including an annual average of 25 cases in children under 12 years of age, based on reports from 1994-1997 inclusive. The current provincial adolescent grade-six hepatitis B immunization program does not protect against childhood infection. The regional health board implemented universal infant hepatitis B immunization in September 1998.

Method: Immunization coverage data were obtained on a random sample of 191 infants born in March 1999 one year after initiation of the program.

Results: By eight months of age, 97.9% of children had received some vaccinations. 73.8% of infants had received three doses of hepatitis B vaccine and 12.6% had received two doses. In comparison, 89% had received three doses and 7.9% two doses of DPTPHib vaccine. 13.1 % of infants had not received any hepatitis B vaccine. For a majority (67%) of these children, their physician's lack of awareness or lack of acceptance of the program constituted the reason for no hepatitis B vaccine uptake. Only one parent cited adverse publicity as the reason for refusing vaccination.

Interpretation: This survey reveals a successful first year of the program without harm to the pre-existing childhood vaccination programs. Hepatitis B vaccine uptake can be improved by increased awareness among physicians and parents.

Hepatitis B virus (HBV) causes a serious infection often leading to acute or chronic hepatitis, liver cirrhosis, liver cancer or death.1 Infected infants have a 90% risk of developing chronic HBV infection due to their inability to clear the HBV.2 Of those with chronic infection, 25-30% will die due to HBVrelated complications. An immunization program aimed at infants has proven to reduce both the incidence of HBV infection and its complications. A 50% reduction in childhood hepatocellular carcinoma has been documented in Taiwan within 10 years of implementation of a universal infant immunization program.3,4

In 1992, the Canadian Paediatric Society recommended a universal HBV vaccination program aimed at infants.1 A program synchronized with the existing childhood vaccination program was considered to be the most cost effective and easiest to implement among the various schedule options. The same year, British Columbia became one of the first provinces to implement a universal HBV immunization program aimed at adolescents. The goals of the provincial HBV immunization program are both to prevent transmission of HBV and to prevent acute and chronic disease due to HBV.

Vancouver/Richmond Health Board (VRHB) has the highest reported rate of newly identified HBV in Canada at 255/100,000 (1997 reported rate). This rate is eight times the rate in the rest of the province. Factors which may account for this difference include large populations of high-risk groups such as immigrants from countries where hepatitis B is endemic, gay and bisexual men and injection drug users. This region also accounts for 60% of all infections reported in BC for children under 12 years of age. The actual numbers of HBV infections may be 10 times greater than the reported rate due to the presence of mild, unrecognized or asymptomatic infections in most children and, to a lesser degree, in adults.5

This program was started in September 1998 due to concerns of HBV infection in children currently unprotected by the provincial program. From 1992-1997 inclusive, an average of 25 cases of hepatitis B were reported per year in children under 12 years of age, and many more unrecognized infections likely occurred. HBV vaccine was added to the infant immunization schedule at 2, 4 and 6 months of age, to be given concurrently with the DPTP-Hib vaccine. All children receiving immunization services in Vancouver/Richmond are eligible for this program. High-risk infants born to carrier mothers are eligible for the HBV prophylaxis (hepatitis B immune globulin and vaccine) at birth and are thus excluded from this program. …

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