Impact of hepatitis B birth dose on immune response in Pakistani children: an open-label, non-inferiority randomized controlled trial, implications for achieving SDG target.

BACKGROUND: Despite presence of hyperendemic areas, the national immunisation schedule in Pakistan does not include a hepatitis B birth dose, placing newborns at an additional risk of acquiring hepatitis B. This study aimed to assess the impact of adding hepatitis B birth dose in existing national vaccination schedule. METHODS: An open label, randomised controlled non-inferiority trial enrolled 296 healthy near-term mothers to intervention and control groups. Newborns in the intervention group received a hepatitis B birth dose along with routine immunisation vaccines, while control group newborns received vaccinations under the national schedule. Seroprotection was measured and compared at birth and 8 weeks after administering the third dose of pentavalent vaccine. The risk ratio of seroprotection was computed and compared with the delta value set at 5%. RESULTS: The study found that 95.8% of infants in the intervention group achieved seroprotection, which was significantly higher than the control group's 58.7%. The difference in risk ratio of seroprotection was 1.62 (CI95: 1.37-1.93), with the upper limit of the CI below the delta margin, confirming non-inferiority. The time interval between birth and the first hepatitis B immunisation shot was a predictor of seroprotection, with an odds ratio of 1.79 (CI95: 1.01-2.9). CONCLUSION: Our study indicates that adding a hepatitis B birth dose to the immunisation schedule in Pakistan is non-inferior to the existing one. This can also contribute towards Pakistan's achievement of the SDG target of reducing hepatitis B surface antigen seroprevalence in children under 5 years of age. TRIAL REGISTRATION NUMBER: NCT04870021.

Hepatitis B vaccination coverage in medical students at a medical college of Mirpurkhas.

OBJECTIVES: To estimate the coverage of Hepatitis B vaccine in medical students enrolled in a private Medical College. METHODS: This cross sectional study was done at Muhammad Medical College Mirpurkhas. It has a total of 375 medical students from first year to final year. All students were interviewed using a pre-structured urdu translated questionnaire to find out the vaccination status of these students and the reasons for not getting vaccinated. RESULTS: A total of 395 medical students were approached to participate in the study but only 375 (95%) students (M=214, F=159) gave response. Out of the total 375 students, 214 (57%) were vaccinated against Hepatitis B. Amongst this group 188 (87.8%) had completed their vaccination schedule of 03 doses and 26 (13%) were partially vaccinated. Vaccination uptake was higher (55.6%) in males as compared to females (44.3%). Reasons of not vaccination were lack of motivation ( 29.2%), no need felt (24.8%), (3) never thought of vaccination (21.7%), fear of injection (10.5%) and lack of belief in vaccination (8.07%). Only 130 (60.7%) students were screened before taking the vaccine. The self reported seropositivity of Hepatitis B Surface Antigen in medical students was 3.7%. CONCLUSIONS: Despite the availability and accessability of a cost effective Hepatitis B vaccine since mid 80's, the vaccination coverage among medical students is low. Health education needs to be improved in all medical students especially in the private sector.

Seropositivity of hepatitis C in prison inmates of Pakistan--a cross sectional study in prisons of Sindh.

OBJECTIVE: To assess the proportion of seropositivity of Hepatitis C amongst the prison inmates in the jails of Sindh. METHODS: A cross sectional HCV seroprevalence survey was done at 14 out of 19 prisons in the Sindh province from November 2008 to January 2009. A team of Pathologist, phlebotomist and laboratory technician took the blood sample of the inmates inside the correctional facility; the blood was centrifuged at the spot and brought back to the pathology laboratory on same day in cold chain i.e. a temperature-controlled supply chain. Serum was analyzed on 3rd generation ELISA for HCV antibodies. Standard ethical considerations were properly followed. RESULTS: Atotal of 9508 prison inmates were approached. Refusal rate was 20%. Remaining, 7539 prisoners were screened at 14 out of 19 jails in Sindh. HCV antibody positive were 965 making the proportion of seropositivity 12.8% (95% C.I. 8.92% - 12.92%). Higher seropositivity in the jails of northern Sindh jails was identified. CONCLUSIONS: Hepatitis C prevalence in the prison population of Sindh is higher than the national prevalence of 4.9% amongst general population. However it is lower than that reported from correctional facilities of developed countries. Hepatitis prevention and control activities in the correctional facilities of Pakistan need to be institutionalized (JPMA 60:476; 2010).