Is it the Right Time to Introduce the Hepatitis B Booster Vaccine in National Immunization Schedule? An Analysis from the Available Evidence

Blood borne infections and Hepatitis B virus immunization levels among medical students in India

BACKGROUND

Medical students are actively involved in direct patient care during their training and subsequent medical practice, making them susceptible to acquiring blood-borne pathogens, including HBV. This study aimed to assess the occurrence of blood-borne infections and the Hepatitis B immunization status among medical students. Furthermore, it sought to identify gaps in risk assessment for blood-borne pathogens among medical students at a Medical College in New Delhi.

METHODS

The study included 108 medical students who participated in a blood donation camp. Blood samples collected from these individuals underwent testing for blood-borne pathogens in accordance with standard screening protocols at the blood bank. The quantitative estimation was performed for anti-HBs IgG using ELISA.

RESULTS

All 108 participants were pursuing their undergraduate or postgraduate medical degrees. All students tested negative for HBsAg and HIV markers and showed no reactivity to Syphilis and Malaria. However, one student tested positive for HCV. Two postgraduate students had a history of needlestick injuries. Eighty-one (75%) students had received Hepatitis B vaccination. Among the vaccinated students, 34 (41.97%) were immunized before the age of five years, 22 (27.16%) after the age of five years, while 25 (30.86%) couldn't recall the exact age of their Hepatitis B vaccination. Protective anti-HBs titer of anti-Hepatitis B antibodies (>10 mIU/ml) were detected in 48.15% (52/108) of students.

CONCLUSIONS

Over 50% of medical students did not possess sufficient immunity against HBV infection, putting them at a heightened risk of acquiring HBV during their active participation in patient care in the near future. It is imperative to establish a policy for routine anti-HBs titer assessment and ensure easy access to Hepatitis B immunization for medical students, thereby enhancing their protection against this infectious agent.

Reducing the infectious diseases burden through "life course approach vaccination" in India-a perspective

The burden of vaccine-preventable diseases is increasing day by day across all age groups. However as per the universal immunization programme, we vaccinate only under-fives and antenatal mothers, a large portion of the vulnerable population remain unvaccinated and the concept of “life course approach” regarding vaccination is missing. It increases the overall burden to the already constrained Indian health care system. As India, now has become the largest manufacturer of multiple vaccines, we have continuous chain healthcare points (primary-tertiary level), with dedicated manpower in the public health sector that is why in this paper we are proposing to expand the horizon of the vaccination process using a “life course approach”. It will not only directly benefit the vulnerable populations (individual level), but also it can benefit the nation, indirectly. Although we may face challenges at multiple phases (conception to implementation), they can be overcome by multisectoral and multipronged innovations.

Role of vaccine science diplomacy in low-middle-income countries for eradicating the vaccine-preventable diseases: Targeting the "LAST MILE"

The meaning of "vaccine diplomacy (VD)" is defined as "the use of vaccines to increase a country's diplomatic relations and influence over other nations." The golden era of vaccine science diplomacy started during the time of Cold War between the United States (US) and the Union of Soviet Socialist Republics (USSR) with the development of a prototype of oral polio vaccine by the US Scientist Dr Albert Sabin working along with his Soviet counterparts. The foundation stone was already laid down by Edward Jenner when he shared his technique of the smallpox vaccine with other major countries to curb the spread of smallpox. Eventually, such a step led to the eradication of such a deadly disease. Only time has changed, not the tide. Even today, vaccines continue to remain as one of the important tools for achieving Millennium Developmental Goals (MDGs) and other targets in developing countries like India. During the wake of the Corona Virus Diseases-19 (COVID-19) pandemic, India's role in developing its vaccine science diplomacy has been a point of attraction. The phase-3 trial of Covaxin being developed by Bharat Biotech started in Lucknow and Gorakhpur in October 2020, and it is widely considered as the forerunner for the Indian vaccine market. As per the Union Health Ministry of India- "The Union Government is working on at least five distinct ways, ranging from free vaccines to guaranteed supply, in which it can help its immediate neighbours and countries in West Asia, Africa and even Latin America-officials familiar with the plan said on conditions of anonymity. The idea is to leverage the country's standing as the world's vaccine factory to merge diplomatic ties. Historically, it is observed that by the development and introduction of newer vaccines from time to time, many dismaying hurdles to vaccine science diplomacy (VSD) arise from ongoing wars and political instability. The current scenario is that both VSD and VD are at crossroads, and there is a possibility of getting a good direction if we make a piggyback policy approach of vaccine diplomacy along with the foreign policy. The lessons learned from the past must be followed now and, in the future, to make a better world for all. We acknowledge that the COVID-19 episode has again highlighted the dire need for VSD, and we assume that not only COVID-19 but in future, emerging and re-emerging diseases will occur so we have to prepare ourselves for combatting those future emerging and re-emerging diseases.