title: Effect of inclusion of hepatitis B vaccine in childhood immunization program in India: a retrospective cohort study.
abstract: OBJECTIVE
  To assess the effectiveness of hepatitis B immunization program in a field setting in India.
  
  
  METHODS
  Serological survey of retrospective cohorts of children, vaccinated or not vaccinated with hepatitis B vaccine.
  
  
  METHODS
  Rural field areas of five districts in Andhra Pradesh state, where childhood hepatitis B immunization began in 2003.
  
  
  METHODS
  Children aged 5-11 years who had received HB immunization (n=2674; 1357 boys) or not received such immunization (n=2350; 1236 boys).
  
  
  METHODS
  Serum HBsAg, anti-HBc and anti-HBs (quantitative) using automated enzyme-immunoassays in the year 2010.
  
  
  RESULTS
  Anti-HBs positivity was higher among immunized than in unimmunized children (53% vs.18%; P<0.001), and anti-HBc positivity was lower (1.1% vs 10.8%: P<0.01). HBsAg positivity was low in both the groups (0.15% and 0.17%; P=0.855). Anti-HBs positivity rate declined with increasing age.
  
  
  CONCLUSIONS
  Administration of hepatitis B vaccine as part of Universal immunization program led to anti-HBs in a large proportion of children and a reduction in anti-HBc positivity, a marker of hepatitis B virus infection. These data provide evidence supporting efficacy of hepatitis B immunization program in an Indian field setting, justifying the decision to include it in the universal immunization program.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow; and *National Institute of Nutrition, Hyderabad, India. Correspondence to: Dr Rakesh Aggarwal, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: J J
authors.initials: JJ
authors.lastname: Babu
authors.forename: R
authors.initials: R
authors.lastname: Hemalatha
authors.forename: Anumulu Venkateshar
authors.initials: AV
authors.lastname: Reddy
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Sharma
authors.forename: Tarun
authors.initials: T
authors.lastname: Kumar
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D017589:Immunization Programs; D007194:India / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines