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Hepatitis B vaccination coverage rates among under-five children in India: a systematic review and meta-analysis
K Divyasree Bhat1,2, Abhinav Sinha1, Haimanti Bhattacharya1
1Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India.
Insights
Hepatitis B vaccination coverage in Indian children under 5 is assessed. This review synthesizes data to understand vaccination rates and inform public health strategies for hepatitis B prevention.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Hepatitis B virus (HBV) infection poses a significant global health burden, leading to cirrhosis, liver cancer, and mortality.
- Despite effective vaccines, hepatitis B remains endemic in low- and middle-income countries like India due to access barriers and low vaccination rates.
- Horizontal transmission is a major HBV infection route in India; completing the vaccine schedule is crucial for prevention.
Purpose of the Study:
- To systematically review and meta-analyze hepatitis B vaccination coverage among children under 5 years in India.
- To estimate pooled vaccination coverage across different Indian regions.
- To identify factors influencing vaccination uptake and inform targeted interventions.
Main Methods:
- A comprehensive literature search of PubMed, Embase, and CINAHL (2000-2024) for studies on "Hepatitis B," "vaccination coverage," "children," and "India."
- Systematic screening of titles, abstracts, and full texts by two independent reviewers.
- Meta-analysis using a random-effects model to estimate pooled coverage, with heterogeneity assessed by I² and Cochran's Q tests. Publication bias evaluated using funnel plots and Egger's test.
Main Results:
- The review will synthesize data on hepatitis B vaccination coverage rates in Indian children under 5.
- Pooled coverage estimates will be presented across various regions of India.
- Analysis will identify variations and potential disparities in vaccination uptake.
Conclusions:
- The findings will provide a comprehensive overview of hepatitis B vaccination coverage in young Indian children.
- Results will highlight areas needing improved vaccination strategies and public health interventions.
- This study aims to contribute to the reduction of the hepatitis B burden in India through evidence-based recommendations.
Background:
Hepatitis B virus (HBV) affects an estimated 1.5 million people globally each year, with nearly 296 million living with chronic infection, contributing significantly to cirrhosis, liver cancer, and premature mortality. Despite the availability of a highly effective vaccine, hepatitis B remains endemic in many low- and middle-income countries, including India, due to barriers in healthcare access and low vaccination uptake. While a timely birth dose prevents perinatal transmission, completion of the full vaccine schedule is essential to prevent horizontal transmission-a major mode of infection in India. India introduced the hepatitis B vaccine in select districts in 2002-2003 and scaled it nationally through the Universal Immunization Programme in 2011-2012.
Objective:
This systematic review and meta-analysis aims to estimate the pooled coverage of hepatitis B vaccination among children under 5 years of age across different regions of India.
Methods And Analysis:
A comprehensive literature search will be conducted using PubMed, Embase, and CINAHL databases to identify studies published between 1 January 2000 and 30 May 2024. The search terms will include "Hepatitis B," "vaccination coverage," "children," and "India," combined using Boolean operators. Two independent reviewers will screen titles, abstracts, and full-text articles for eligibility. The AXIS tool will be used to assess the quality of cross-sectional studies. Pooled coverage rates will be estimated using a random-effects meta-analysis model. Heterogeneity will be assessed using the I 2 statistic and Cochran's Q test. Publication bias will be evaluated through funnel plots and Egger's test. Sensitivity and subgroup analyses will be conducted to explore the robustness of results and sources of heterogeneity.
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