Epidemiology of childhood hepatitis B in India: vaccination related issues

It has been estimated that presently hepatitis B kills more people every day than AIDS kills in a year world-wide. Infection with hepatitis B produces a wide range of manifestations ranging from asymptomatic carriers to persistent infections leading to chronic liver diseases and hepatocellular carcinoma. Availability of effective and safe vaccine has made all this preventable. To formulate on appropriate vaccination strategy for India the epidemiology of hepatitis B needs to be defined. This report critically reviews the available data. The burden of long term sequelae of HBV infection is probably under-diagnosed and under-reported in India. Prevalence studies of HBV markers indicate that India falls under the area of intermediate endemicity. Limited data on age-specific prevalence of HBV markers suggests that the majority of the infection seems to take place below 15 years of age, and most of it under one year. Perinatal transmission appears to contribute significantly to the carrier pool. Childhood vaccination for HB among the general population is the obvious strategy of choice. But more information is required to decide on the timing of the first dose.