Abstract
OBJECTIVE--To determine the efficacy of hepatitis B vaccine when added to the routine expanded programme on immunisation under field conditions in rural Africa. DESIGN--Infants were immunised according to two schedules--an early schedule at birth, 3 months, and 6 months and a later schedule to correspond with routine vaccination in the expanded programme on immunisation at 3 months, 4 1/2 months, and 6 months. SETTING--Venda, northern Transvaal, South Africa, a self governing region of 7460 square kilometers varying from rural villages to small towns. SUBJECTS--The 1989 birth cohort of Venda. MAIN OUTCOME MEASURES--Coverage for hepatitis B vaccine at first, second, and third doses; serological assessment of vaccine efficacy by prevalence of antibodies to hepatitis B surface antigen in infants who had completed the three dose course of immunisation; antibodies to hepatitis B core antigen to determine if natural infection occurred. RESULTS--Vaccine coverage for hepatitis B dropped sharply from 99% to 53% to 39% for the first, second, and third dose respectively. In contrast, vaccine coverage was maintained at 97-99% for the three doses of poliomyelitis vaccine. Serological evaluation of vaccine efficacy showed that only 3.5% of recipients of all three doses failed to develop antibodies to hepatitis B surface antigen. Only 6.6% of vaccine recipients were vaccinated according to either the early or later schedules whereas 93.4% received their doses of vaccine at intervals beyond the limits of either of the planned schedules. There was, however, no significant difference in seroconversion to the surface antigen between the "unscheduled" or scheduled groups of those who were vaccinated according to the early or late schedules. The pattern of prevalence of antibodies to hepatitis B core antigen, which showed a sharp fall in children aged over 7 months, suggested that the antibodies were acquired passively rather than by active infection. CONCLUSIONS--Supplementation of the present expanded programme on immunisation with hepatitis B vaccine in rural Africa is fraught with difficulties. However, the vaccine was effective within a fairly wide spacing of dosage. Adding hepatitis B vaccine to diphtheria, tetanus, and pertussis as a tetravalent vaccine is proposed as a means of effectively integrating it into the expanded programme on immunisation in Third World settings.
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- Botha J. F., Ritchie M. J., Dusheiko G. M., Mouton H. W., Kew M. C. Hepatitis B virus carrier state in black children in Ovamboland: role of perinatal and horizontal infection. Lancet. 1984 Jun 2;1(8388):1210–1212. doi: 10.1016/s0140-6736(84)91694-5. [DOI] [PubMed] [Google Scholar]
- Chen D. S., Hsu N. H., Sung J. L., Hsu T. C., Hsu S. T., Kuo Y. T., Lo K. J., Shih Y. T. A mass vaccination program in Taiwan against hepatitis B virus infection in infants of hepatitis B surface antigen-carrier mothers. JAMA. 1987 May 15;257(19):2597–2603. [PubMed] [Google Scholar]
- Coursaget P., Yvonnet B., Bourdil C., Mevelec M. N., Adamowicz P., Barrès J. L., Chotard J., N'Doye R., Diop Mar I., Chiron J. P. HBsAG positive reactivity in man not due to hepatitis B virus. Lancet. 1987 Dec 12;2(8572):1354–1358. doi: 10.1016/s0140-6736(87)91255-4. [DOI] [PubMed] [Google Scholar]
- Coursaget P., Yvonnet B., Chotard J., Sarr M., Vincelot P., N'doye R., Diop-Mar I., Chiron J. P. Seven-year study of hepatitis B vaccine efficacy in infants from an endemic area (Senegal). Lancet. 1986 Nov 15;2(8516):1143–1145. doi: 10.1016/s0140-6736(86)90543-x. [DOI] [PubMed] [Google Scholar]
- Coursaget P., Yvonnet B., Relyveld E. H., Barres J. L., Diop-Mar I., Chiron J. P. Simultaneous administration of diphtheria-tetanus-pertussis-polio and hepatitis B vaccines in a simplified immunization program: immune response to diphtheria toxoid, tetanus toxoid, pertussis, and hepatitis B surface antigen. Infect Immun. 1986 Mar;51(3):784–787. doi: 10.1128/iai.51.3.784-787.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dusheiko G. M., Brink B. A., Conradie J. D., Marimuthu T., Sher R. Regional prevalence of hepatitis B, delta, and human immunodeficiency virus infection in southern Africa: a large population survey. Am J Epidemiol. 1989 Jan;129(1):138–145. doi: 10.1093/oxfordjournals.aje.a115102. [DOI] [PubMed] [Google Scholar]
- Goh K. T., Doraisingham S., Tan K. L., Oon C. J., Ho M. L., Chen A. J., Chan S. H. The hepatitis B immunization programme in Singapore. Bull World Health Organ. 1989;67(1):65–70. [PMC free article] [PubMed] [Google Scholar]
- Hepatitis B vaccine in the expanded programme of immunisation: The Gambian experience. The Gambia Hepatitis Study Group. Lancet. 1989 May 13;1(8646):1057–1059. [PubMed] [Google Scholar]
- Maynard J. E., Kane M. A., Hadler S. C. Global control of hepatitis B through vaccination: role of hepatitis B vaccine in the Expanded Programme on Immunization. Rev Infect Dis. 1989 May-Jun;11 (Suppl 3):S574–S578. doi: 10.1093/clinids/11.supplement_3.s574. [DOI] [PubMed] [Google Scholar]
- Prozesky O. W., Szmuness W., Stevens C. E., Kew M. C., Harley E. J., Hoyland J. A., Scholtz J. E., Mitchell A. D., Shabangu A., Kunene E. Baseline epidemiological studies for a hepatitis B vaccine trial in Kangwane. S Afr Med J. 1983 Nov 26;64(23):891–893. [PubMed] [Google Scholar]
- Smego R. A., Jr, Halsey N. A. The case for routine hepatitis B immunization in infancy for populations at increased risk. Pediatr Infect Dis J. 1987 Jan;6(1):11–19. doi: 10.1097/00006454-198701000-00005. [DOI] [PubMed] [Google Scholar]
- Yvonnet B., Coursaget P., Chotard J., Sarr M., NDoye R., Chiron J. P., Diop-Mar I. Hepatitis B vaccine in infants from an endemic area: long-term anti-HBs persistence and revaccination. J Med Virol. 1987 Aug;22(4):315–321. doi: 10.1002/jmv.1890220404. [DOI] [PubMed] [Google Scholar]