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HiBand Hep B
1. Epidemiology of HepB and Hib diseases in India Dr Pradeep Haldar AC(I) SEPIO meeting 18-20 May 2011
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3. Hepatitis B Virus – Modes of Transmission From mother to baby (perinatal transmission) From child to child during play or from an adult to child by contact of body fluids; (Most common cause in India) Unscreened blood transfusions and organ transplant Through unsafe needles and injections Through unprotected sexual contact
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6. Hepatitis B infection: Age and outcome Infection during infancy – very high chance of becoming chronic
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9. Overview of Hepatitis B Expansion GAVI support areas where Hepatitis B vaccination Started Sno On going States Districts Covered Sno Added States Hepatitis B Vaccination 1 Andhra Pradesh Entire State 22 Uttarakhand States Proposed for Expansion 2 Himachal Pradesh 23 Arunachal Pradesh 3 Jammu & Kashmir 24 Bihar 4 Karnataka 25 Chandigarh 5 Kerala 26 Chattisgarh 6 Madhya Pradesh 27 D & N Haveli 7 Maharashtra 28 Daman & Diu 8 Punjab 29 Tripura 9 Tamil Nadu 30 Sikkim 10 West Bengal 31 Manipur 11 A & N Islands* 32 Meghalaya 12 Delhi* 33 Mizoram 13 Goa* 34 Nagaland 14 Lakshadweep* 35 Jharkhand 15 Puducherry* 16 Assam Selected Area(s) Jorhat, Sibsagar Remaining districts 17 Gujarat Ahmedabad, Surat, Vadodara 18 Haryana Panchkula, Ambala 19 Orissa Sundergarh 20 Rajasthan Jaipur 21 Uttar Pradesh Kanpur, Lucknow
12. Causes of <5 mortality in India, 2005 Neonatal deaths 43% Bassani 2010, Million Death Study Total pneumonia 23%
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16. Undetected Disease including meningitis and pneumonia Additional cases preventable with vaccination Can be identified by surveillance for invasive disease Surveillance underestimates the burden of Hib disease
29. Outcomes: Case Fatality Author/Year Syndrome CFR (%) Kabra 1991 Hib meningitis 25 Steinhoff 1998 Hib meningitis 29 Thomas 2002 Hib meningitis 20 Chinchankar 2002 Hib meningitis 21 Thomas 2002 Any invasive Hib disease 16
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Editor's Notes
We can do very little to help all those who are already infected. It is possible to protect the future generations by vaccinating infants. Hepatitis B vaccine in India’s UIP could help prevent about 10 lakh chronic infections and 1.5 lakh deaths in each year’s birth cohort.
To stimulate interest put the choices to voting. Most people are unlikely to select the second choice. And they are surprised to know it when you show the last line creating interest. Child to Child (including Adult to child) also known as horizontal transmission accounts for most HBV infections. It is supported by the fact that there is familial clustering of HBsAg positivity among small children is frequently noticed in families where adults (usually a male adult) are HBsAg positive and there is no contact through blood/ sex.
Infections in first year of life almost always (90%) end up in becoming chronic
Please note the Age of Infection on the x-axis—the major epidemiological change occurs after the 1 st to 4 th year of life.
Immunization provided to infants has the highest impact on reducing the chronic infections in the community.
Etiology study locations: Deivanayagam, 1993, Chennai; Singhi, 2002, Chandigarh; Mani, 2007, Banglalore; Chinchankar, 2002, Pune; Steinhoff, 1998, New Delhi, Lucknow, Madras, Nagpur, Trivandrum and Vellore
Remember you’ll need to say Haemophilus influenzae type b (“or Hib”) first time you use the terms
In persons with cirrhosis, the liver tissue is found replaced with fibrous and fatty tissue. The liver appears nodular. Hepatocellular carcinoma (HCC or liver cancer) may also develop in the chornically infected liver tissue.
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