Poor uptake of hepatitis B vaccine in India has several causes, study finds

BMJ 2013; 346 doi: (Published 06 June 2013) Cite this as: BMJ 2013;346:f3596
  1. Cheryl Travasso
  1. 1Mumbai

Poor management of vaccine stocks, poor record keeping, lack of staff training, and use of multidose vials were among the main reasons for low coverage of the hepatitis B vaccine in 10 states across India, researchers have found.

India is home to 11% of the world’s people with chronic hepatitis B and has between 100 000 and 200 000 deaths from hepatocellular carcinoma or cirrhosis each year. To tackle the disease, India introduced the hepatitis B vaccine across 10 states in 2007-08 as part of its universal immunisation programme. The vaccine was meant to be administered to infants alongside the diphtheria, pertussis, and tetanus (DPT) and oral polio vaccines.

However, initial reports indicated that coverage of the hepatitis B vaccine was lower than that of DPT, prompting the India National Polio Surveillance Project at the World Health Organization to assess the situation, after a request from India’s Ministry of Health and Family Welfare. It assessed 10 districts across five states that included better and poorly performing areas. The gap in coverage between DPT (three doses) and hepatitis B (three doses) ranged from 0% to 45%. The study highlighted a disparity of performance within states and the need for careful monitoring, even if a state’s overall performance seemed to be good. 1

The study also found that healthcare staff were often reluctant to open 10-dose vials of vaccine if only one or two children were available for vaccinations, because they were concerned about wastage.

Chandrakant Lahariya, the study’s lead author, said that well drafted operational guidelines to be distributed well ahead of time of vaccination programmes and adapted for different healthcare professionals would help to improve the introduction and uptake of a new vaccine in the community. Good quality training, community awareness, and continuous monitoring, especially during the initial phase of a vaccine’s introduction, were also important.

In April this year Shri Abu Hasem Khan Choudhury, the minister of state for health and family welfare, announced that a pentavalent vaccine that included hepatitis B and Haemophilus influenzae B in addition to diphtheria, pertussis, and tetanus had begun in the states of Goa, Gujarat, Haryana, Jammu and Kashmir, Karnataka, Kerala, Puducherry, and Tamil Nadu.2

Lahariya suggested that a pentavalent vaccine would be more acceptable to parents and healthcare professionals, as it required fewer injections and less cold chain space, with minimum syringe wastage.


Cite this as: BMJ 2013;346:f3596