Hepatitis B and BCG vaccinationbirth dose (Maternity ward)

Appreviations:• HepB : Hepatitis B • BCG: Bacile Calmette Guerin• HIV: Human Immunodeficiency

Virus.• NIP: National Immunization

Program

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Hepatitis B vaccineIntroduction

Hepatitis B (Hep B) is a viral infection in the blood that cause liver problems including liver cancer.

If a mother is infected with Hep B, the virus can be transmitted to the baby during birth.

90% of baby infected with Hep b around the time of birth will carry the infection for life (chronic).

25% of babies who develop chronic infection will die of liver failure or liver cancer later in life.

Because of don’t feel sick, most people do not know they have the infection.

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Hep B vaccine- con’tPrevention of perinatal HBV transmission In order to prevent HBV transmission from mother to infant, the first dose of HB vaccine needs to be given as soon as possible after birth (preferably within 24 hours). (WHO)

The NIP policy recommends Hep B birth vaccine is given within 24 hrs after birth, as this is when it is most effective. It can be given up to 7 days where this can not be achieved.

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Hep B vaccine- con’tPresentationHepatitis B vaccines are available in liquid single-

dose glass vials.Injection equipment0.5 ml auto-disable (AD) syringes are

recommended. If AD syringes are not available, standard

disposable syringes (1 ml or 2 ml with 22/23 gauge needle is recommended) must be used ONCE ONLY.

DosageThe standard paediatric dose is 0.5 ml.Route Intramuscular (IM) injection into the right thigh.

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Hep B vaccine- con’tAll the baby should have Hep B vaccine.

◦ Low birth weight baby◦ Premature baby◦ Jaundice (yellow)◦ And HIV mother should still given Hep B vaccine.

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Hep B vaccine- con’tMinimal side effect:

◦Local pain (3-29/100)◦Myalgia◦Transient fever (mostly within 24hrs) (1-6/100)◦Swelling (3/100)◦Erythema (3/100)◦Headache (3/100)

Severe reaction: anaphylaxis (1.1/1000000)

WHO: observe rate of vaccine reaction, June 2012

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Hepatitis B Injection

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BCG vaccineIntroduction

BCG (Bacille Calmette Guerin) called Mycobacterium bovis which is closely related to Mycobacterium tuberculosis, the agent responsible for tuberculosis. It is prevent children getting more severe forms of TB, particularly TB meningitis.

It is freeze-dried and need to be mixed with the correct diluent from the same manufacturer before administration

Dose: a vial with 20doses, dose for new born is 0.05ml.Route: ID into the R) upper arm. BCG vaccine vials must be discarded 6hrs after mixing. BCG can give up to baby 1 year old.

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BCG vaccination:Mild side effect

◦ Papule may be red, tender and indurated (2-4wks).

◦ The papule commences two or more weeks after vaccination and then may progress to become ulcerated healing after 2-5 months leaving a superficial scar.

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BCG vaccination (con’t)Severe adverse effect (rarely)

◦Local abscess ◦Keloid ◦Lymphadenitis◦Suppuration (onset 2-6 months)- 1per 1000-

100000◦Systemic (1-12 months onset time)◦Cutaneous skin lesions◦Osteitis (1/3333-100000000)◦Disseminated BCG◦Immune Reconstitution Syndrome: collection

of inflammatory disorders

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BCG and Hep B vaccine Contraindications:

Absolute contraindicationsAnaphylaxis after a previous

dose.Immunodeficiency: do not give

BCG vaccine to an infant who is known to be infected with HIV, even if they have no symptoms. Other vaccine can be given.

Relative contraindicationsTemperature > 38.5. children

with minor cough and colds can safely immunized.

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Vaccine vial monitors (VVMs)

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BCG injection site

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Reference: WHO