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http://www.timesofoman.com/newsdetails.asp?newsid=45902
Monday, December 01, 2003
Mass vaccination of adults against hepatitis B ‘inappropriate’
ISLAMABAD — The increasing demand for mass vaccination of adults against
hepatitis B is not based on a scientific and technical appraisal of
the
perceived threat of infection, Executive Director of the National Institute
of Health (NIH) Dr Athar Saeed Dil has said.
Globally, adult immunisation is only recommended for high-risk groups
including injection drug users, healthcare workers who have a high
chance
of needle prick injury and contact with infected blood or body fluids
of
infected persons; household contacts of chronically infected persons,
commercial sex workers, and persons with multiple sex partners or a
diagnosis of sexually transmitted disease, he said.
Dr Dil was asked to comment on the increasing demand from various quarters
for initiation of mass vaccination for adults against hepatitis B.
“Mass
immunisation of adults is certainly not the answer and is not recommended,”
he stated.
Chronic infection occurs in 90 per cent of infants infected at birth,
in 30
per cent children infected at age 1-5 years and only 6 per cent persons
infected after five years of age. The consequences of hepatitis B infection
thus depend on age at infection, explained Dr Dil.
The NIH executive director said it was unusual for those infected later
in
adult life to become chronic carriers of the virus. The argument,
therefore, forms the basis of having a mass immunisation programme
for
infants to protect them from this deadly disease.
According to some experts, and even looking at it hypothetically, adult
immunisation in the country would cost around Rs10 billion, which is
a huge
amount in comparison with the risk factor. In Pakistan, though there
are no
nationwide community-based studies to measure the prevalence of hepatitis
B
virus, the blood screening data of the country shows that the average
prevalence of hepatitis B stands at 2.5 per cent in blood donors and
7.8
per cent among health workers.
The prevalence among commercial sex workers is estimated to be around
11.7
per cent whereas among those with chronic liver diseases, it stands
at 33.5
per cent. In pregnant women, it is estimated at 3.64 per cent.
“The current strategy in the country has an overall goal of eliminating
hepatitis B transmission because most of the serious consequences related
to the disease occur among persons with chronic hepatitis B infection
and
its consequences, cirrhosis and liver cancer,” Dr Dil said.
Dr Dil said the government has in place, a programme to save the future
generation of the country from this scourge and for this purpose, universal
immunisation of all children under one year of age is now a part of
Pakistan’s routine immunisation programme which provides for free
immunisation against deadly diseases to all children from birth to
nine
months of age.
The cost of immunising children under one year against hepatitis-B is
estimated at over Rs347 million. The challenge of arranging resources
of
such magnitude was overcome with the support of the Global Alliance
for
Vaccines and Immunisation to meet the cost. This, Dr Dil said, was
a major
achievement. The public at large needs to be educated on avoiding
unnecessary use of injections, he said, recommending the following
steps:
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Ensure that in case of need for blood transfusion, the blood is screened
for hepatitis B.
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Avoid going to roadside dentists since they do not have sterilised equipment;
insist on a new blade while visiting the barber; do not share razors, toothbrushes
or any personal care item that might have blood on it, and do not go for
body piercing or tattooing from anywhere as the instruments used could
transmit the infection.
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Pregnant mothers must be screened for hepatitis B.
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Persons infected with the disease must not donate blood, organs or tissue.
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Should restrict oneself to one sexual partner; those associated with healthcare
must ensure that they follow standard precautions while handling needles
and other sharps. — Internews
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