E-DRUG: Blanket hepatits B vaccination questionable in India
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[copied as fair use; WB]
http://bmj.bmjjournals.com/cgi/content/full/332/7547/976
Blanket hepatitis B vaccination is questionable in India
EDITORWe agree with Banatvala et al that adequate economic analysis of universal hepatitis B vaccination is required before recommending policy change in Britain.1 In India plans for universal hepatitis B vaccination have been announced without an economic comparison with other programmes that may be more cost effective. The marginal cost-efficacy of hepatitis B vaccine in India has been estimated,2 but it has not been compared with investing in the current expanded programme of immunisation, which currently achieves complete primary immunisation of only 35% of eligible children.3 Hepatitis B vaccine is more expensive than the combined cost of the vaccines for the six other diseases covered by the current programme. These six diseasesmeasles, diphtheria, pertussis, tetanus, polio, and tuberculosisprobably cause more harm than hepatitis B. The World Health Organization recommends universal hepatitis B vaccination when hepatitis B carrier rates are above 2%.4 The often quoted estimate for India of 4.7% is based on incorrectly pooling results of a set of studies including unrepresentative high risk groups and equating the single test HBsAg positivity rate with the carrier rate. Correcting these errors yields a carrier rate of 1.42%.5 In India the most important mode of transmission for hepatitis B is perinatal. Preventing perinatal transmission requires that newborns be given the first dose of the vaccine within 12 hours of birth. However, in India most births take place at home, where the logistics of timely vaccine delivery are beyond India's resources. Consequently most newborn infants (the most vulnerable group) will not be protected from perinatal transmission by "universal" vaccination. In developing countries such as India, an open debate, informed by accurate data and thorough economic analysis of competing priorities, is needed before a final decision is taken about universal hepatitis B vaccination.
Peter R Mansfield, director Healthy Skepticism, Willunga, SA 5041, Australia peter.mansfield@adelaide.edu.au
Anant Phadke, Ashok Kale Healthy Skepticism, Willunga, SA 5041, Australia
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