Bottom
line
Tyagi et al 2003 suggest that an intervention that costs more per life year
saved, than the per capita GNP of the country is not cost beneficial. The per
capita GNP in India is about Rs 20250
By this reckoning, interventions that cost more than Rs 20250 per life year
saved (after discounting) are not cost beneficial for India.
The cost of the hepatitis B program is 5 times (without the birth dose) to 10
times (with birth dose) the percapita GNP, per life year saved. The program is
therefore too costly and there are no commensurate benefits.
5. Evidence of the success of the pilot project
GAVI funded the pilot study in India and it was a success we are told
(statement of minister of Health quoted by times of India). We looked for
evidence from evaluations of the pilot study.
Carrier rate in pilot area (against historic controls)
What is the carrier rate among children under 5 years in cities where the
pilot was conducted compared to the carrier rate before the introduction of
this prophylaxis? Only one paper from tribals in Andamans who were
vaccinated at birth( Murhekar 2004)
Carrier rate in those immunised starting at 6 weeks
What is the carrier rate among children vaccinated at 6, 10 and 14 weeks in
the pilot area compared to those who received the birth dose? This would help
answer the question about the importance of the first dose within 48 hours of
birth.
There is no data
Carrier rate in those immunized (compared to those not immunized)
This would be more useful than using historic controls
There is no data
Vaccine uptake in the pilot project areas
We have one study from East Delhi that says that the coverage with hepatitis B
was 14% - only marginally more than the baseline 9% before the vaccine was
made available free of cost by the GAVI (Sokhey et al 2001)
Another study from Delhi found coverage of 19 to 21.6% (Dasgupta R et al
2002.)
What else is known from the pilot study?
We know 270 million rupees have been spent. This is perhaps the only real
mark of success.
Bottom line
There is no evidence that the pilot project was a success.
6. Evidence in international literature of efficacy of a 6, 10, 14 week
immunization strategy
A systematic search was made of international literature to see if there was
evidence that the 6,10, 14 week schedule of immunization or any similar
schedule has been utilized and found to be effective in reducing HBsAg
prevalence.
Search strategy
Pubmed ("hepatitis b"[MeSH Terms] OR hepatitis b[Text Word]) AND ("epidemiology"[Subheading]
OR "prevalence"[MeSH Terms] OR prevalence[Text Word]) AND after[All Fields]
AND (immunization[Text Word] OR immunisation[Text Word] OR "immunization"[MeSH
Terms]) 324 hits.
Results
Although papers from Taiwan(Cheng 2003, Ni YH 2001, Kao 2001, Lin 2002, Lee
200)
China (Gong 2003) Iran(Zali 2005) USA (Mahony 2003) Italy (DaVilla 1998,
Zanetti 2001 Mele 2002) Thailand (Poovorawan 2000) Andamans India ( Murhekar
2004) Nigeria (Odusanya et al 2005) showed reduction in carrier rate
after universal immunization starting at birth, we found no papers where
immunization starting at 6 weeks has been proven efficacious
Bottom line
There are no
studies from anywhere in the world where the 6, 10, 14 week schedule of
immunization has been employed and shown to be useful.
7. Conclusions
1. Systematic review suggests that prevalence of Hepatitis B in India among
non-tribals is 2.13% (CI 1.83 – 2.46). The incidence among tribals is
significantly higher at 19.455%(CI 15.35-23.55).
The data regarding tribals must be seen separately so that this vulnerable
group gets the attention needed.
2. The data of the ICMR cancer registry, which estimates 5000 deaths from HCC
due to HBV seems robust.
3. There is no data collected from the pilot program to suggest that universal
immunization with Hepatitis B is feasible, affordable or efficacious.
4. There is no evidence in world literature to suggest that immunization
starting at 6 weeks can bring down the prevalence of hepatitis B.
5. The program is expected to cost Rs 500 crores. Benefits have to be
discounted as they will accrue about 40 years in the future. If vaccination is
to start at birth most of this allocation will get spent on delivery of the
first dose of the vaccine within 48 hours of birth
The INASL had recommended urgent need for data on benefits in spite of missing
the birth dose. (INASL 2000) The information can be derived from studies in
the pilot area
Scaling up from a donor-funded pilot study costing Rs 27 crores, to universal
immunization which is to cost the Indian exchequer Rs 500 crores yearly, seems
difficult to justify in the absence of an evaluation of the pilot project
Recommendation for research
An evaluation of the pilot study will cost a very small fraction of the Rs 500
crores needed each year for universal immunization.
Immunization coverage with hepatitis B must be studied in children born in the
pilot areas.
Carrier rates among those who have not received any hepatitis B vaccine must
be compared with carriers among those that received the vaccine at birth and
those that received it, starting at six weeks.
Bottom line
The study in the pilot areas would cost a fraction of the yearly
expenditure of embarking on the program of universal immunization. Embarking
on this program without collecting data that is easily available from the
pilot study would be irresponsible and difficult to defend.
8.
References
Abass F, Thomas RD Rajkumar A Gupta N Puliyel JM. Controlling perinatally
acquired hepatitis B. Indian J Pediatr 2001 Apr;68(4):365.
Agarwal R, Ghoshal UC, Naik SR Assessment of cost-effectiveness of universal
hepatitis B immunization in a low income country with intermediate endemicity
using a Markov model Journal of Hepatology 2003;38:215-22)
Aggarwal SR, Sarin SK, Underestimation of cost of hepatitis B vaccine in India
Reply Indian J of Gastroenterology 2001;20:206
Ahmad B Grover R Ratho RK, Mahajan RC. Prevalence of hepatitis B virus
infection in Chandigarh over a six year period. Tropial Gastroenterol. 2001
Jan-Mar;22(1):18-9.
Aldershville J, Dieterichson O, Skinhoj P, Kryger P, Mathiesen LR,
Christoffersen P, et al. Chronic persistent hepatitis : serological
classification and meaning of the HBe system. Hepatology 1982; 2: 243-246.
Alward WLM, McMahon BJ, Hall DB, Heyward WL, Francis DP, Bender TP. The long
term serological course of asymptomatic hepatitis B virus carriers and the
development of primary hepatocellular carcinoma. J Infect Dis 1985; 151:
604-609.
Anderson KE, Sun SC, Berg HS, Chang NK. Liver function and histology in
asymptomatic Chinese military personnel with hepatitis B antigenemia. Dig Dis
Sci 1974; 19: 693-703.
Andre FE. Summary of safety and efficacy data on a yeast-derived hepatitis B
vaccine. Am J Med 1989; 87(suppl 3A): 14-20.
Arora NK, Agadi SN. Hepatitis B immunization - A practical approach for India.
Indian J Pediatr 1998; 65: S72- S74.
Banerjee A, Chakravarty R, Mondal PN, Chakraborty MS. Hepatitis B virus
genotype D infection among antenatal patients attending a maternity hospital
in Calcutta, India: assessment of infectivity status. Southeast Asian J Trop
Med Public Health. 2005 Jan;36(1):203-6.
Beasley RP, Hwang LY, Lee GCY, Lan CC, Roan CH, Huang FY, Chen CL. Prevention
of perinatally transmitted hepatitis B virus infection with hepatitis B immune
globulin and hepatitis B vaccine. Lancet 1983; i: 1099-1102.
Beasley RP, Hwang LY, Lin CC, Leu ML, Stevens CE, Szmuness W, et al. Incidence
of hepatitis B virus infections in preschool children in Taiwan. J Infect Dis
1982; 146: 198-204.
Beasley RP, Hwang LY, Stevens CE, Lin CC, Hsieh FJ, Wang KY, et al. Efficacy
of hepatitis B immune globulin for prevention of perinatal transmission of the
hepatitis B virus carrier state :
Final report of a randomized double-blind, placebo controlled trial.
Hepatology 1983; 3: 135-141.
Beasley RP, Hwang LY. Postnatal infectivity of hepatitis B surface
antigen-carrier mothers. J Infect Dis 1983; 147: 185-190.
Beasley RP, Shiao IS, Wu TC, Hwang LY. Hepatoma in an HBsAg carrier seven
years after perinatal infection. J Pediatr 1982; 101: 83-84.
Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical
transmission of hepatitis B surface antigen. Am J Epidemiol 1977; 105: 94-98.
Beasley RP. Hepatitis B. The major etiology of hepatocellular carcinoma.
Cancer 1988; 61: 1942-1956.
Bhagyalaxmi A, Lala MK, Jain S, Sunderam S, Nayak S, Kalia M, Patel N. HBsAg
carrier status in urban population of Ahmedabad city. Indian J Med Res. 2005
Mar;121(3):203-4.
Biswas SC, Gupta I, Ganguly NK, Chawla Y, Dilawari JB. Prevalence of hepatitis
B surface antigen in pregnant mothers and its perinatal transmission. Trans
Royal Soc Trop Med Hyg 1989; 83: 698-700.
Biswas SC, Gupta I, Ganguly NK, Chawla Y, Dilawari JB. Prevalence of hepatitis
B surface antigen in pregnant mothers and its perinatal transmission. Trans
Royal Soc Trop Med Hyg 1989; 83: 698-700.
Bloom BS, Hillman AL, Fendrick AM, Schwartz JS. A reappraisal of Hepatitis B
virus vaccination strategies using cost effectiveness analysis. Ann Intern Med
1993; 118: 298- 306.
Bortolotti F, Cadrobbi P, Armigliato M, Rude L, Rugge M, Realdi G. Prognosis
of chronic hepatitis B transmitted from HBsAg positive mothers. Arch Dis Child
1987; 62: 201-203.
Bortolotti F, Cadrobbi P, Crivellaro C, Alberti A, Rugge M, Bertaggia A, et
al. Changes in hepatitis B e antigen / antibody system in children with
chronic hepatitis B virus infection. J Pediatr 1983;
103: 718-722.
Bortolotti F, Cadrobbi P, Crivellaro C, Bertaggia A, Albertic A, Realdi G.
Chronic hepatitis type B is childhood: Longitudinal study of 35 cases. Gut
1981; 22: 499-504.
Bortolotti F, Cadrobbi P, Crivellaro C, Guido M, Pugge M, Noventa F, et al.
Long term outcome of chronic type B hepatitis B in patients who acquire
hepatitis B virus infection in childhood. Gastroenterology 1990; 99: 805-810.
Bortolotti F, Calzia R, Cadrobbi P, Giacchini R, Ciravegna B, Armigliato M, et
al. Liver cirrhosis associated with chronic hepatitis B infection in
childhood. J Pediatr 1986; 108: 224- 27.
Bortolotti F, Calzia R, Vegnente A, Cadrobbi P, Rugge M, Armigliato M, et al.
Chronic hepatitis in childhood: the spectrum of disease. Gut 1988; 29:
659-664.
Bortolotti F, Wirth S, Crivellaro C, Alberti A. Long term persistence of
hepatitis B virus DNA in the serum of children with chronic hepatitis B after
hepatitis B e antigen to antibody seroconversion. J Pediatr Gastroenterol Nutr
1996; 22: 270-274.
Caraman WF, Thomas HC. Genetic variation in hepatitis B virus.
Gastroenterology 1992; 102: 711
Chadha MS, Arankalle VA. Ten year serological follow up of hepatitis B vaccine
recipients. Indian J Gastroenterol 2000; 19: 168-171.
Chadwick RG, Galizzi J, Heathcote J, Lyssiotis T, Cohen BJ, Scheuer PJ, et al.
Chronic persistent hepatitis : hepatitis B markers and histological follow-up.
Gut 1979; 20: 372-377.
Chakravarti A, Rawat D, Jain M. A study on the perinatal transmission of the
hepatitis B virus. Indian J Med Microbiol. 2005 Apr;23(2):128-30.
Chandra M, Khaja MN, Farees N, Poduri CD, Hussain MM, Aejaz Habeeb M,
Habibullah CM. Prevalence, risk factors and genotype distribution of HCV and
HBV infection in the tribal population: a community based study in south
India. Trop Gastroenterol. 2003 Oct-Dec;24(4):193-5
Chandrasekaran S, Palaniappan N, Krishnan V, Mohan G, Chandrasekaran N.
Relative prevalence of hepatitis B viral markers and hepatitis C virus
antibodies (anti HCV) in Madurai, south India. Indian J Med Sci. 2000
Jul;54(7):270-3.
Chang MH Decreasing incidence of hepatocellular carcinoma among children
following universal hepatitis B immunization. Liver Int 2003 Oct;23(5):309-14.
Chang MH, Hwang LY, Hsu CH, Lee CY, Beasley RP. Prospective study of
Asymptomatic HBsAg carrier children infected in the perinatal period: Clinical
and liver histologic studies. Hepatology 1988; 8: 374-377.
Chang MW, Sung JL, Lee CY, Chen CJ, Chen JS, Hsu HY, et al. Factors affecting
clearance of hepatitis B e antigen in hepatitis B surface antigen carrier
children. J Pediatr 1989; 115: 385-390.
Chen HL ChangCJ Kong MS ey al Pediatric fulminant hepatic failure in endemic
areas of hepatitis B infection: 15 years after universal hepatitis B
vaccination. Hepatology 2004 Jan;39(1):58-63.
Choudhary N, Ramesh V, Saraswati S, Naik S. Effectiveness of mandatory
transmissible disease screening in Indian blood banks. Indian J Med Res 1995;
101: 229-332.
Chowdhury A, Santra A, Chakravorty R, Banerji A, Pal S, Dhali GK, Datta S,
Banerji S, Manna B, Chowdhury SR, Bhattacharya SK, Mazumder DG.Community-based
epidemiology of hepatitis B virus infection in West Bengal, India: prevalence
of hepatitis B e antigen-negative infection and associated viral variants. J
Gastroenterol Hepatol. 2005 Nov;20(11):1712-20.
Committee on Immunization of the Indian Academy of Pediatrics. IAP GuideBook
on Immunization. Indian Academy of Pediatrics, Mumbai, 1996; 27-32.
Dasgupta R Health Policy Planning 2002;17;99-105
Datta SK, Gulati AK, Pandy LK, Pandey S. Hepatitis B virus carriage in
pregnant women. J Com Dis 1988; 20: 209-212.
Davis LG, Weber DJ, Lemon SM. Horizontal transmission of hepatitis B virus.
Lancet 1989; i : 889-893.
de Franchis R, Meucci G, Vecchi M, Tatarella M, Colombo M, Ninno ED, et al.
The natural history of asymptomatic hepatitis B surface antigen carriers. Ann
Intern Med 1993; 118: 191-194.
de Groote J, Fevery J, Lepontre L. Long term followup of chronic active
hepatitis of moderate severity. Gut 1978; 19: 510-513.
de Jongh FE, Janssen HLA, deMan RA, Hop WCJ, Schalm SW, Blankenstein MV.
Survival and prognostic indicators in hepatitis B surface antigen positive
cirrhosis of the liver. Gastroenterology 1992; 103: 1630-1635.
Dhir V, Mohandas KM. Epidemiology of digestive tract cancers in India 3.
Liver. Ind J of Gastroenterol1998;17:100-3
Dhorje SP, Pavri KM, Prased SR, Sehgal A, Phule B. Horizontal transmission of
hepatitis B virus infection in household contacts, Pune, India. J Med Virol
1985; 16: 183-189.
Dietrichson O. Chronic persistent hepatitis: A clinical, serological and
prognostic study. Scand J Gastroenterol 1975; 10: 249-255.
Dodd RY. The risk of transfusion-transmitted infection. N Engl J Med 1992;
327: 419-421.
Dormeyor HH, Arnold W, Schonborn H, Braun B, Klinge O, Pfiefer U, et al. The
significance of serologic, histologic and immunologic findings of 88
asymptomatic carriers of hepatitis B surface antigen. J Infect Dis 1981; 144;
33-37.
Dragosics B, Ferenci P, Hitchman E, Denk H. Long term follow up study of
asymptomatic HBsAg-positive voluntary blood donors in Austria : a clinical and
histologic evaluation of 242 cases. Hepatology 1987; 7: 302-306.
Dudley FJ, Scheuer PJ, Sherlock S. Natural history of hepatitis associated
antigen positive chronic liver disease. Lancet 1972; ii: 1388-1393.
Elavia AJ, Banker DD. Prevalence of hepatitis B surface antigen and its
subtypes in high risk group subjects and voluntary blood donors in Bombay.
Indian J Med Res 1991; 93: 280-285.
Elavia AJ, Banker DD. Prevalence of hepatitis B surface antigen and its
subtypes in high risk group subjects and voluntary blood donors in Bombay.
Indian J Med Res 1991; 93: 280-285.
Fattovich G, Brollo L, Giustina G, Noventa F, Pontisso P, Alberti A, et al.
Natural history and prognostic factors for chronic hepatitis type B. Gut 1991;
32: 294-298.
Fattovich G, Giustina G, Schalm SW, Hadziyannis S, Sanchez-Tapias J, Almasio
P, et al. Occurrence of hepatocellular carcinoma and decompensation in western
European patients with cirrhosis type B. Hepatology 1995; 21: 77- 82.
Feinman SV, Berris B, Cooper N, Sinclair JC, Wrobel DM. Results of a long term
prospective study of the hepatitis B surface antigen (HBsAg) carrier state.
Hepatogastroenterology 1982; 29: 58-61.
Ganju SA Goel A. Sero-surveillance of HIV, HBV and HCV infections in antenatal
and STD clinic attendees. J Commun Dis. 2004 Mar;36(1):60-2.
Garg S, Mathur RD, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and
syphilis in replacement and voluntary blood donors in western India. .Indian J
Pathol Microbiol. 2001 Oct;44(4):409-12.
Gong J, Li RC, Yang JY, et al [Long-term efficacy of infant hepatitis B
immunization program] Zhonghua Gan Zang Za Zhi 2003;11:203-5
Gupta I, Sehgal A, Sehgal R, Ganguly NK, Vertical transmission of hepatitis B
in North India. J Hyg Epid Microbiol Immunol 1992; 36: 263-267.
Gupta N,Kumar V,Kaur A . Seroprevalence of HIV, HBV, HCV and syphilis in
voluntary blood donors.
Hadziyannis SJ. Chronic viral hepatitis. Clin Gastroenterol 1974; 3: 381-408.
Hepatitis B leading to hepatocellular carcinoma: calculating the risk.
(Reply) Indian J Gastroenterol. 2001 Nov-Dec;20(6):251-2. )
Hollinger FB, Mosley JW, Szmuness W. Non-A, Non-B hepatitis following blood
transfusion, risk factors associated with donor character-istics. In: Szmuness
W, Alter HJ, Maynard JE, eds. Viral
hepatitis–1981 International Sympo-sium. Philadelphia: Franklin Institute
Press; 1982: 361-376.
Hollinger FB. Hepatitis B vaccines-to switch or not to switch. JAMA 1987; 257:
2634-2636.
Hopkins GB, Gostling JVT, Hill I, McNab DJN, Mullan DP, Scutt RWB, et al.
Hepatitis after tattooing: A fatal case. BMJ 1973; 3: 210-211.
Hsu HC, Wu MZ, Chang MH, Su IJ, Chen DS. Childhood hepatocellular carcinoma
develops exclusively in hepatitis B surface antigen carriers in three decades
in Taiwan : a report of 51 cases strongly associated with rapid development of
liver cirrhosis. J Hepatology 1987; 5: 260-267.
Indian Association for Study of the Liver (INSAL ); 2000 Hepatitis B in India;
therapeutic options and prevention strategies – Consensus statement. Indian J
of Gastroenterology. 19:C4-C66. Reply to responses:
Indian Council of Medical Research. National Cancer Registry Program Biennial
report 1988-1989 ICMR New Delhi
Indian Council of Medical Research. National Cancer Registry Program Five year
consolidated report of hospital based cancer registries 1994-1998 ICMR New
Delhi
Indian Council of Medical Research. National Cancer Registry Program Two year
report of hospital based cancer registries 1999-2000 ICMR New Delhi
Indian Council of Medical Research. National Cancer Registry Program Two year
population based cancer registries 1997-1998 ICMR New Delhi
Indian Council of Medical Research. National Cancer Registry Program Two year
report of population based cancer registries 1999-2000 ICMR New Delhi
Indian Council of Medical Research. National Cancer Registry Program
Consolidated report of the population based cancer registries 1990-1996ICMR
New Delhi
Irshad M, Joshi YK, Acharya SK, Tandon BN. Prevalence of hepatitis B virus
infection in healthy persons in North India. Natl Med J India 1994; 7:
210-212.
Irshad M, Joshi YK, Acharya SK, Tandon BN. Prevalence of hepatitis B virus
infection in healthy persons in North India. Natl Med J India 1994; 7:
210-212.
Jain RC, Bhat SD, Sangle S. Prevalence of Hepatitis B surface antigen among
rural population of Loni area in Ahmednagar district of western Maharashtra
JAPI 1992; 40: 390-391.
Johnson CJ, Anderson H, Spearman J, Madson J. Ear piercing and hepatitis:
nonsterile instruments for ear piercing and the subsequent onset of viral
hepatitis. JAMA 1974; 227: 1165.
Joshi RM, Gupta V, Jain B, Kumar S, Basu S. Screening for HBsAg, anti-HIV,
anti-HCV and syphilis amongst blood donors in a teaching hospital.
Joshi SH, Gorakshakar AC, Mukherjee M, Rao VR, Sathe MS, Anabhavane SM, et al.
Prevalence of HBsAg carriers among some tribes of Madhya Pradesh. Indian J Med
Res 1990; 91: 340-343.
Kao JH, Hsu HM, Shau WY Chang MH Chen DS. Universal hepatitis B vaccination
and the decreased mortality from fulminant hepatitis in infants in Taiwan. J
Pediatr.2001 Sep;139(3):349-52.
Karayannis RA, Tassopoulos N, Richardson SC, Kalafatas P. How often does
chronic liver disease follow acute hepatitis B in adults? Infection 1985; 4:
174-176.
Kaur H, Marshalla R Seroepidemiology of HIV, HBV, HCV and treponemal
infections. : J Commun Dis. 1998 Mar;30(1):29-31.
Kaur R,Berry N,Mittal SK,Mathur M d,BavejaU. Hepatitis B virus in a select
pediatric population in Delhi, India.
Khatri JV, Kulkarni KV, Vaishnav PR, Merchant SM. Vertical transmission of
hepatitis B. Indian Pediatr 1980; 27: 957-962.
Khuroo MS, Duermeyer W, Zargar SA, Ahanger MA, Shah MA. Acute sporadic non-A,
non-B hepatitis in India. Am J Epidem 1983; 118: 360- 364.
Kim CY, Kim JW, Lee HS, Yoon YB, Song IS. Natural history and survival rate of
hepatitis B virus infection in Korea. Korean J Med 1994; 46: 168-180.
Koff RS. Natural history of acute hepatitis B in adults reexamined.
Gastroenterology 1987; 92: 2035-2037.
Kulkarni ML, Reddy PV. Prevalence of HBsAg in asymptomatic carrier mothers and
vertical transmission in South India. Am J Dis Child 1988; 142: 124-125.
Kurien T, Thyagarajan SP, Jeyaseelan L, Peedicayil A, Rajendran P, Sivaram S,
Hansdak SG, Renu G, Krishnamurthy P, Sudhakar K, Varghese JC; STD Study
Group.Community prevalence of hepatitis B infection and modes of transmission
in Tamil Nadu, India.Indian J Med Res. 2005 May;121(5):670-5.
Lee CL Hsieh KS, Ko YC. Trends in the incidence of hepatocellular carcinoma in
boys and girls in Taiwan after large-scale hepatitis B vaccination. Cancer
Epidemol Biomarkers Prev 2003 Jan;12(1):57-9
Lee MS, Kim DH, Kim H, Lee HS, Kim CY, Park TS et al. Hepatitis B vaccination
and reduced risk of primary liver cancer among male adults: a cohort study in
Korea. Int J Epidemiol 1998; 27: 316-319.
Lee PI, Chang MH, Lee CY, Hsu HY, Chen JS, Chen PJ, et al. Changes of serum
hepatitis B virus DNA and aminotransferase levels during the course of chronic
hepatitis B virus infection in children. Hepatology 1990; 12: 657- 660.
Lee PI, Lee CY, Huang LM, Chang MH. Long term efficacy of recombinant
hepatitis B vaccine and risk of natural infection in infants born to mothers
with hepatitis B e antigen. J Pediatr 1995; 126: 716-721.
Liaw YF, Lin DY, Chen TJ, Chu CM. Natural course after the development of
cirrhosis in patients with chronic type B hepatitis: a prospective study.
Liver 1989; 9: 235- 241.
Liaw Y-F, Sheen IS, Chu LM, Chen C-J. Chronic hepatitis with non-specific
histological changes. Is it a distinct variant of chronic hepatitis? Liver
1984; 4: 55-60.
Liaw YF, Sung JL. Liver biopsy in asymptomatic carriers of HBsAg (Letter).
Gastroenterology 1979; 76: 1084.
Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients
with chronic type B hepatitis: A prospective study. Hepatology 1988; 8:
493-496.
Liaw YF, Tai DI, Chu CM, Lin DY, Sheen IS, Chen TJ, et al. Early detection of
hepatocellular carcinoma in patients with chronic type B hepatitis: A
prospective study. Gastroenterology 1986; 90: 263-267.
Limentani AE, Elliott CM, Noak ND, Lamborn JK. An outbreak of hepatitis B from
tattooing. Lancet 1979; ii: 86-88.
Lin HH, Lin SS, Chiang YM et al. Trend of hepatitis B virus infection in
freshmen classes at two high schools in Hualien, Taiwan from 1991 to 1999. J
Med Virol. 2002 Aug;67(4):472-6.
Lo KJ, Tong MJ, Chien ML, Liaw YF, Yang KC, Chian H, et al. The natural course
of hepatitis B surface antigen positive chronic active hepatitis in Taiwan. J
Infect Dis 1982; 146: 205-210.
Lo KJ, Tsai YT, Lee SD, Wu TC, Wang JY, Chen GH, et al. Immunoprophylaxis of
infection with hepatitis B virus in infants born to hepatitis B surface
antigen-positive carrier mothers. J Infect Dis 1985; 152: 817-822.
Lok ASF, Lai CL. A longitudinal followup of asymptomatic hepatitis B surface
antigen-positive Chinese children. Hepatology 1988; 8: 1130-33.
Maggiore G, Giacomo CD, Marzani D, Sessa F, Scotta MS. Chronic viral hepatitis
B virus in infancy. J Pediatr 1983; 103: 749-752.
Mahalakshmi B, Madhavan HN, Pushpalatha R, Margarita S. Seroprevalence of
human immunodeficiency virus, hepatitis B virus and hepatitis C virus among
eye donors.
Makroo RN, Hassain G, Koul A, Shah GN. Prevalence of Hepatitis B surface
antigen in Kashmiri blood donors. Indian J Med Res 1989; 89: 310-313.
Makroo RN, Hassain G, Koul A, Shah GN. Prevalence of Hepatitis B surface
antigen in Kashmiri blood donors. Indian J Med Res 1989; 89: 310-313.
Marion SA, Tomm Pastore M, Pi DW, Mathias RG. Long term follow up of hepatitis
B vaccine in infants of carrier mothers. Am J Epidem 1994; 140: 734-746.
Mayor S.Liver cancer in Taiwan falls after universal hepatitis B vaccination.
BMJ7 Jul 5;315(7099):7.
McMahon BJ, Alberts SR, Wainwright RB, Bulkow L, Lanier AP. Hepatitis
B-related sequelae. Prospective study in 1400 Hepatitis B surface
antigen-positive Alaska native carriers. Ann Intern
Med 1990; 150: 1051-1054.
McMahon BJ, Alward WLM, Hall DB, Heyward WL, Bender TR, Francis DP, et al.
Acute hepatitis B virus infection: relation of age to the clinical expression
of disease and subsequent development of the carrier state. J Infect Dis 1985;
151: 599-603.
Mele A, Stroffolini T, Zanetti AR. Hepatitis B in Italy: where we are ten
years after the introduction of mass vaccination J Med Virol 2002; 67:440-3
Miller M, Kane M. Routine hepatitis B immunization in India:
Cost-effectiveness assessment Ind J of Pediatrics 2000;67:299-300
Miller MA Policy analysis of the use of Hepatitis B, Hemophilius type B,
Streptococcus pneuomniae-conjugate and Rotavirus vaccines in the national
immunization schedules (Reply) Health Economics 2004;9:1147-8) as also in the
calculation of the Indian Association for Study of the Liver (INSAL )
Mitch WE, Wands JR, Maddrey WC. Hepatitis B transmission in a family. JAMA
1974; 227: 1043-1044.
Mittal SK, Rastogi A, Saini N. Hepatitis vaccines in India- Current concepts
and future prospects. Indian J Pediatr 1998; 65: S64- S71.
Mohite JB, Urhekar AD. Prevalence of HBsAg positivity in staff and patients at
MGM Medical College and Hospital, Navi-Mumbai. : Indian J Med Sci. 1999
Oct;53(10):434-8.
Mosley JW. The epidemiology of viral hepatitis: an overview. Am J Med Sci
1975; 270: 253-270.
Murvekar MV, Chakravarty R, Murvekar KM, Banerjee A, Sehgal SC Hepatitis B
virus genotypes among the Jarawas: A primitive Negrito tribe of Andaman and
Nicobar Islands, India. Arch Virol. 2006 Mar 3.
Murvekar MV, Murvekar KM, Arankalle VA et al. Epidemiology of hepatitis B
infection among the Nicobarese--a mongoloid tribe of the Andaman and Nicobar
Islands, India. : Epidemiol Infect. 2002 Jun;128(3):465-71.
Murvekar MV, Murvekar KM, Das D, et al. Prevalence of hepatitis B infection
among the primitive tribes of Andaman & Nicobar Islands. : Indian Med Res 2000
Jun;111:199-203.
Murvekar MV, Murvekar KM, Sehgal SC Age-specific prevalence of hepatitis B
infection among the Karen in the Andaman and Nicobar Islands, India. : Trop
Doct. 2004 Apr;34(2):117-8.
Murvekar MV, Murvekar KM Sehgal SC et al. Hepatitis B vaccination in a
hyper-endemic tribal community from India: assessment after three years.
Vaccine 2004 Dec 2;23(3):399-403.
Murvekar MV, Murvekar KM, Sehgal SC Seroepidemiology of hepatitis B infection
among tribal school children in Andaman and Nicobar Islands, India. : Ann Trop
Paediatr. 2004 Mar;24(1):85-8.
Murvekar MV, Murvekar KM, Sehgal SC. Alarming prevalence of hepatitis-B
infection among the Jarawas--a primitive Negrito tribe of Andaman and Nicobar
Islands, India. : J Viral Hepat. 2003 May;10(3):232-3.
Nandi J Bhawaalkar V, Mody H, Elavia A et al Detection of HIV-1, HBV and HCV
antibodies in blood donors from Surat, western India. : Vox Sang
994;67(4):406-7.
Nandi J, Banerjee K. Detection of hepatitis B virus DNA in donor blood by
polymerase chain reaction. Natl Med J India 1992; 5: 5-7.
Nanu A, Sharma SP, Chatterjee K, Jyoti P. Markers for
transfusion-transmissible infections in north Indian voluntary and replacement
blood donors: prevalence and trends 1989-1996. : Vox Sang 1997;73(2):70-3.
Nayak NC, Panda SK, Zuckerman AJ, Bhan MK, Guha DK. Dynamics and impact of
perinatal transmission of Hepatitis B virus in North India. J Med Virol 1987;
21: 137- 145.
Ni YH Chang MH Huang LM et al. Hepatitis B virus infection in children and
adolescents in a hyperendemic area: 15 years after mass hepatitis B
vaccination. Ann Intern Med. 2001 Nov 6;135(9):796-800.
Nielson JO, Dietrichson O, Elling P, Christoffersen P. Incidence and meaning
of persistence of Australia antigen in patients with acute viral hepatitis:
development of chronic hepatitis. N Engl J Med 1971; 285: 1157- 60.
Nijhawan S, Rai RR, Sharma D, Saxena HB. HBsAg prevalence in blood donors in
Jaipur. Abstract in Indian J Gastroenterol 1997; 16 (52): A-103.
Okuda K, Nahashima T, Sakamato K, Ikari T, Hidata H, Kubo Y, et al.
Hepatocellular carcinoma arising in non-cirrhotics and highly cirrhotic liver:
A comparative study of histopathology and frequency of hepatitis B markers.
Cancer 1982; 49: 450-55.
Panda SK, Ramesh R, Rao KVS, Gupta A, Zuckerman AJ, Nayak NC. Comparative
evaluation of the immunogenicity of yeast derived (recombinant) and plasma
derived Hepatitis B vaccine in infants. J Med Virol 1991; 35: 297-302.
Pandya S. Mass immunization for MMR and Hepatitis B at schools and camps.
Academy Today 1998 (September); 6.
Patel Y. Seroprevalence of HIV, HBV, HCV and syphilis in blood donors. Indian
J Med Sci. 2004 Jul;58(7):306-7.
Patrick DM, Bigham M, Ng H, et al. Elimination of acute hepatitis B among
adolescents after one decade of an immunization program targeting Grade 6
students. Pediatr Infect Dis J. 2003 Oct;22(10):874-7.
Piccinino F, Sagnelli E, Manzillo G, Pasquale G. Liver histology in 34 HBsAg
long term healthy carriers. Acta Hepato-Gastroenterol 1977; 23: 148-154.
Poovawan Y, Theamboonlers A Vimolket T et al. Impact of hepatitis B
immunisation as part of the EPI. Vaccine2000 Nov 22;19(7-8):943-9.
Poovorawan Y, Sanpavat S, Chumderm-padetsuk S, Safary A. Long term hepatitis B
vaccine in infants born to hepatitis B e antigen positive mothers. Arch Dis
Child 1997; 77: F47-F51.
Poovorawan Y, Sanpavat W, Pongpunlert W, Chumdermpadetsuk S, Sentrakul P,
Chitinand S, et al. Comparision of a recombinant DNA hepatitis B vaccine alone
or in combination with hepatitis B immune globulin for prevention of perinatal
acquisition of hepatitis B carriage. Vaccine 1990; 18 (suppl): S56-S59.
Popper H, Shafritz DA, Hoofnagle JH. Relation of the hepatitis B virus carrier
state to hepatocellular carcinoma. Hepatology 1987; 4: 764-772.
Qamer S, Shahab T, Alam S, Malik A, Afzal K. Age-specific prevalence of
hepatitis B surface antigen in pediatric population of Aligarh, North India.
Indian J Pediatr. 2004 Nov;71(11):965-7.
Reddy PH, Tedder RS. Hepatitis virus markers in the Baiga tribal population of
Madhya Pradesh, India. Trans Royal Soc Trop Med Hyg 1995; 89(6): 620.
Reinicke V, Dybkjaer E, Poulsen H, Banke O, Lylloff K, Nordenfelt E. A study
of Australia antigen positive blood donors and their recepients with special
reference to liver histology. N Engl J Med 1972; 286: 867-870.
Ruiz-Moreno M, Camps T, Aguado JG, Porres JC, Oliva H, Bartolome J, et al.
Serological and histological follow up of chronic hepatitis B infection. Arch
Dis Child 1989; 64: 1165- 1169.
Saha V, John TJ, Dhamodharan S, Carman RH. Highly sensitive screening tests
for hepatitis B surface antigen in transfusion centers of developing
countries. BMJ 1988; 297: 334- 335.
Sahani M, Jindal K, Abraham N, Aruldas K, Puliyel J Hepatitis B immunization:
cost calculations in a community-based study in India. Indian J Gastroenterol
2004;23:16-8
Sakuma K, Saitoh N, Kasai M, Jitsukawa H, Yshino I, Yamaguchi M, et al.
Relative risks of death due to liver disease among Japanese male adults having
various statuses for hepatitis B and e antigen/antibody in serum: A
prospective study. Hepatology 1988; 8: 1642-1646.
Salleras L, Dominguez A, Bruguera M, et al.Dramatic decline in acute hepatitis
B infection and disease incidence rates among adolescents and young people
after 12 years of a mass hepatitis B vaccination programme of pre-adolescents
in the schools of Catalonia (Spain). Vaccine. 2005 Mar 18;23(17-18):2181-4.
Sampliner RE, Hamilton FA, Iseri OA, Tabor E, Boitnott J. The liver histology
and frequency of clearance of the hepatitis B surface antigen (HBsAg) in
chronic carriers. Am J Med Sci 1979; 277: 17-22.
Sarin SK Hepatitis B leading to hepatocellular carcinoma: calculating the risk
Reply Indian J Gasteroenterology 2001;20:252
Sarin SK Underestimating cost of hepatitis B vaccine in India Reply Ind J of
Gastroenterology 2002;21:87
Sarin SK Understanding the cost of hepatitis B vaccine in India (Reply Ind J
Gasterentrol 2002; 21:87
Sarkar K, Ganguly DN, Bal B, Saha MK, Bhattacharya SK .Hepatitis B infection,
Eastern India.Emerg Infect Dis. 2004 Jul;10(7):1341-2.
Satoskar A, Ray V. Prevalence of hepatitis B surface antigen (HBsAg) in blood
donors from Bombay. : Trop Geogr Med.1992 Jan;44(1-2):119-21.
Seeff LB, Beebe GW, Hoofnagle JH, Norman JE, Buskell-Bales Z, Waggoner JG, et
al. A serological followup of the 1942 epidemic of post vaccination hepatitis
in the United States Army. N Engl J Med 1987; 316: 965-970.
Sehgal A, Gupta I, Sehgal R, Ganguly NK. Hepatitis B vaccine alone or in
combination with anti HBs immunoglobulin in the perinatal prophylaxis of
babies born to HBsAg carrier mothers. Acta Virol 1992; 36: 359-366.
Sharma R Malik A Rattan A et al Hepatitis B virus infection in pregnant women
and its transmission to infants. : J Trop Pediatr1996 Dec;42(6):352-4.
Sharma RR, Cheema R, Vajpayee M, Rao U, Kumar S, Marwaha N, Agnihotri SK.
Prevalence of markers of transfusion transmissible diseases in voluntary and
replacement blood donors. Natl Med J India. 2004 Jan-Feb;17(1):19-21.
Shenoy S, Baliga S, Prashanth HV, Dominic RM, Haridas S. Prevalence of
hepatitis B surface antigen (HBsAG) in pregnant women in South Kanara
District, Karnataka State, India. Trop Doct. 2004 Apr;34(2):98-9
Sherman M, Peltekian KM, Lee C. Screening for hepatocellular carcinoma in
chronic carriers of hepatitis B virus: Incidence and prevalence of
hepatocellular carcinoma in a North American urban population. Hepatology
1995; 22: 432-438.
Singh B, Kataria SP ,Gupta R.Infectious markers in blood donors of East
Delhi:pervalence and trends. Indian J pathol Microbiol.2004 Oct;47[4]:477-9.
Singh H,Aggarwal R,Singh RL,Naik SR,Naik S. Frequency of infection by
hepatitis B virus and its surface mutants in a northern Indian
population.Indian J Gastroenterology.2003 Jul-Aug;22[4]:121-3.
Singh J, Bhatia R, Gandhi JC, Kaswekar AP, Khare S, Patel SB, et al. Outbreak
of viral hepatitis B in a rural community linked to inadequately sterilized
needles and syringes Bull WHO 1998; 76: 93-98.
Singh J, Bhatia R, Khare S, Patnaik SK, Biswas S, Lal S, Jain DC, Sokhey J.
Community studies on prevalence of HBsAg in two urban populations of southern
India. Indian Pediatr. 2000 Feb;37(2):149-52
Singh J, Prakash C, Gupta RS, Bora D, Jain DC, Datta KK. Epidemiology of
endemic viral hepatitis in an urban area of India: a retrospective community
study in Alwar. Bull WHO 1997; 75: 463- 468.
Singhvi A, Pulimood RB, John TJ, Babu PG, Samuel BU, Padankatti T, et al. The
prevalence of markers for Hepatitis B and human immuno-deficiency viruses,
malarial parasites and microfilaria in blood donors in a large hospital in
South India. J Trop Med Hyg 1990; 93: 178-182.
Singhvi A, Pulimood RB, John TJ, Babu PG, Samuel BU, Padankatti T, et al. The
prevalence of markers for Hepatitis B and human immuno-deficiency viruses,
malarial parasites and microfilaria in blood donors in a large hospital in
South India. J Trop Med Hyg 1990; 93: 178-182.
Sobeslavsky O. Prevalence of markers of hepatitis B virus infection in various
coun- tries: a WHO collaborative study. Bull WHO 1980; 58: 621-628.
Sokhey J et al J Trop Ped 2001;47:199-203
Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B
antigen in Taiwan. N Engl J Med 1975; 292: 771-774.
Sumathy S, Thyagarajan SP, Latif R, Madana-gopalan, Raguram K, Rajasambandam
P, et al. A dipstick immunobinding enzyme-linked immunosorbent assay for
serodiagnosis of hepatitis B and delta virus infections. J Virol Methods 1995;
38: 145-152.
Sumathy S, Thyagarajan SP, Latif R, Madana-gopalan, Raguram K, Rajasambandam
P, et al. A dipstick immunobinding enzyme-linked immunosorbent assay for
serodiagnosis of hepatitis B and delta virus infections. J Virol Methods 1995;
38: 145-152.
Szmuness W, Harley EJ, Ikram H, Stevens CE. Sociodemographic aspects of the
epidemiology of hepatitis B. In: Vyas GN, Cohen SN, Schmid R, eds. Viral
hepatitis. Philadelphia, Franklin Institute Press. 1978: 297-320.
Takano S, Yokosuka O, Imazeki F, Tagawa M, Omata M. Incidence of
hepatocellular carci-noma in chronic hepatitis B and C: A pros-pective study
of 251 patients. Hepatology 1995; 21: 650- 655.
Tandon BN, Gandhi BM, Joshi YK, Irshad M, Gupta H. Hepatitis virus non-A,
non-B: the cause of major public health problem in India. Bull WHO 1985; 63:
931- 934.
Tandon BN, Gandhi BM, Joshi YK. Etiological spectrum of viral hepatitis and
prevalence of markers of hepatitis A and B virus infection in north India.
Bull WHO 1984; 62: 67- 73.
Tandon BN, Irshad M Raju M et al Prevalence of HBsAg & anti-HBs in children &
strategy suggested for immunisation in India. : Ind J Med Res.1991
Nov;93:337-9.
Tandon BN, Irshad M, Raju M, Mathur GP, Rao MN. Prevalence of HBsAg and anti
HBsAg in children and strategy suggested for immunization in India. Indian J
Med Res 1991; 93: 337-339.
Tapp E, Jones DM, Hollanders D, Dymock IW. Serial liver biopsies in blood
donors with persistent HBs antigenemia. J Clin Pathol 1976; 29: 884-886.
Tassopoulous NC, Papaevangelou GJ, Sjogren MH, Karayanmis AR, Gerin JL,
Purcell RH. Natural history of acute hepatitis B- surface antigen positive
hepatitis in Greek adults. Gastroenterology 1987; 92: 1844-1850.
Thakur TJ, Sharma V, Goyal A, Gupta ML. Seroprevalence of HIV antibodies,
Australia antigen and VDRL reactivity in Himachal Pradesh. Indian J Med Sci
1991; 45: 332-335.
Thakur TJ, Sharma V, Goyal A, Gupta ML. Seroprevalence of HIV antibodies,
Australia antigen and VDRL reactivity in Himachal Pradesh. Indian J Med Sci
1991; 45: 332-335.
Tong MJ, Thursby MW, Lin J-H, Weissman JV, McPeak CM. Studies on the maternal
-infant transmission of the hepatitis B virus and HBV infection within
families. Prog Med Virol 1981; 27: 137-147.
Trevisan A, Cadrobbi P, Crivellaro C, Bortolotti F, Rugge M, Realdi G.
Virologic features of chronic hepatitis B virus infection in childhood. J
Pediatr 1982; 100: 366- 72.
Troisi CL, Hollinger FB, Hoots WK, Contant C, Gill J, Ragni M, et al. A
multicenter study of viral hepatitis in a United States hemophilic population.
Blood 1993; 81: 412-418.
Tu XM, Litvak E, Pagano M. Issues in human immuno-deficiency virus (HIV)
screening programs. Am J Epidemiol 1992; 136: 244-255.
Tyagi V, Singh SK, Sawhney A, Taneja V, Puliyel JM. Using gross national
product to calculate acceptable immunization costs. Deploying
cost-effectiveness calculations in reverse . Pharmacoeconomics 2003;21:497-99
Velasco M, Gonzalez-Ceron M, de la Feunte C, Ruiz A, Donor S, Katz R. Clinical
and pathological study of asymptomatic carriers in Chile. Gut 1978; 19:
569-571.
Villeneuve JP, Desrochers M, Infante-Rivard C, Willems B, Raymond G, Bourcier
M, et al. A long term follow up study of asymptomatic hepatitis B surface
antigen positive carriers in Montreal. Gastroenterology 1994; 106: 1000-1005.
Villeneuve JP, Richer G, Cote J, Guevin R, Marleau D, Joly JG, et al. Chronic
carriers of hepatitis B antigen (HBsAg). Am J Dig Dis 1976; 21: 18-25.
VinodKumar CS, Anandkumar H, Kapur I, Ratna AK. Seroprevalence of HBV among
people visiting barbers at Gulbarga. J Commun Dis. 2002 Jun;34(2):154-6.
Viola LA, Barison IG, Coleman JC, Paradinas FJ, Murray-Lyon IM. The HBe
antigen antibody system and its relationship to clinical and laboratory
findings in 100 chronic HBsAg carriers in Great Britain. J Med Virol 1981; 8:
169-175.
Vittal SB, Dourdourekas D, Shobassy N, Gerber M, Telischi M, Szanto PB, et al.
Asymptomatic hepatic disease in blood donors with hepatitis B antigenemia. Am
J Clin Pathol 1974; 62: 649-654.
Weissberg J, Andres L, Smith CI, Weick S, Nichols JE, Garcia G, et al.
Survival in chronic hepatitis B : an analysis of 379 patients. Ann Intern Med
1984; 101: 613-616.
Werner GT, Frosner GG, Sareen DK. Prevalence of serological markers for viral
hepatitis and AIDS in rural Punjab. : J Commun Dis. 1989 Jun;21(2):139-41.
WHO Expanded Programme on Immunization. Hepatitis B control through
immunization. Global programme for vaccines and immunization sub-committee
meeting of the scientific advisory group of experts. Geneva, 12-16 June, 1995.
WHO Prevention of Hepatitis B in India An overview. SEA-Hepat.-5 SEA-EPI-141
WHO Regional office for South East Asia New Delhi 2002
Wong VCW, Ip HMH, Reesink HW, Lelie PN, Reerink-Brongers EE, Yeung CY, Ma HK.
Prevention of the HBsAg carrier state in newborn infants of mothers who are
chronic carriers of HBsAg and HBeAg by administration of hepatitis B vaccine
and hepatitis B immunoglobulin: Double blind placebo controlled study. Lancet
1984; i: 921-926.
Woolf IL, Boyes BE, Jones DM, Whittaker JS, Tapp E, MacSwan RNM, et al.
Asymptomatic liver disease in hepatitis B antigen carriers. J Clin Pathol
1974; 27: 348-352.
Wu TC, Tong MJ, Hwang B, Lee SD, Hu MM. Primary hepatocellular carcinoma and
hepatitis B infection during childhood. Hepatology 1987; 7: 46-48.
Xu ZY, Liu CB, Francis DP. Prevention of perinatal acquisition of hepatitis B
virus carriage using vaccine : Prelimnary report of a randomized, double blind
placebo controlled and comparative trial. Pediatrics 1985; 76: 713-718.
Zali MR, Mohammad K, Noorbala AA et al. of hepatitis B seropositivity
following mass vaccination in the Islamic Republic of Iran.East Mediterr
Health J.2005 Jan-Mar;11(1-2):62-7. |