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Hepatitis B incurs a significant impact and burden on society worldwide and adversely affects the lives of children, adolescents and their families (Zanetti, Van Damme & Shouval, 2008, p. 6266; World Health Organization [WHO], 2013; National Centre for Immunisation Research & Surveillance [NCIRS], 2012, p. 2). Extensive immunisation programs are recommended to reduce the rates of hepatitis B and its economic costs on the population (WHO, 2008; Williams, 2002, p. 458). This essay will analyse hepatitis B immunisation as a health intervention strategy and the impact of associated mortality and morbidity on Australian population (NCIRS, 2012, p. 1-2). This will be done by focussing on the needs for hepatitis B immunisation and the goals of immunisation program. This will be followed by analysing the implementation of the hepatitis B vaccination programs together with their effectiveness on population health for children and families.
WHO (2013) defines hepatitis B as an infectious disease in which the “hepatitis B virus (HBV)” causes the inflammation of the liver by affecting its function. The morbidity of hepatitis B has a significant impact on infants, children and adolescents (NCIRS, 2012, p. 1-2; Ni, 2011, p.2; Levy, 2012, p. 206). Studies show that hepatitis B can have a negative effect on the liver function which may lead to chronic liver condition followed by the development of cirrhosis and liver cancer (Zanetti et al., 2008, p.6267; Ni, 2011, p.2; Rots, Wijmenga-Monsuur, Luytjes, Kaaijk, Graaf, Van Der Zeijst & Boog, 2010, p. 893). NCIRS (2012) stated that the rate of death related to the hepatitis B was “the tenth leading cause” of mortality worldwide due to chronic liver infection. Statistics also show that the percentage of hepatitis B disease in Australia is much lower in comparison to the other countries; however, this rate may increase because of the contribution of infected immigrants to the country (Zanetti et al., 2008, p. 6266; NCIRS, 2012, p. 2; Gidding, Warlow, Maclntyre, Backhouse, Gilbert, Quinn & Mclntyre, 2007, p. 8640; Levi, 2012, p. 206). The hepatitis B virus has been shown to be spread via blood and blood contaminated instruments and this impacted by different factors such as age, gender and the status of immune system (Ni, 2011, p. 1; Rots et al., 2010.p. 894, 897; Zanetti et al., 2008, p. 6266). It is stated that infants and children may be affected by hepatitis B disease by being exposed to the hepatitis B antigen carrier mother directly via blood particularly at times of birth (NCIRS, 2012, p. 3; Ni, 2011, p. 2; Rots et al., 2010, p. 894; Roznovsky, Pliskova, Orsagova, Kloudova, Tvrdik, Kabieszova, Lochman, Mrazek, Hozakova & Zjevikova, 2010, p. 395). Statistics showed that boys were more susceptible to hepatitis B than girls and this was attributed to a correspondingly greater number of the chronic liver infection for males later in their life (Ni, 2011, p. 4). Also where the immune system is considered to be compromised by HBV, it may result in more complicated health related issues (Ni, 2011, p. 4). The transmission of HBV may readily spread indirectly via blood contaminated instruments during surgery and “needle stick injuries” in clinics as well as through contact with infectious person within the family (NCIRS, 2012, p. 3; Ni, 2011, p. 2; Zanetti et al., 2008, p. 6266).
The hepatitis B immunisation programs sanctioned in Australia were aimed at reducing the impact and burden of hepatitis B disease on its population (Gidding et al., 2007, p. 8637). It is emphasised that the prevention of the development of hepatitis B disease is considered to be less expensive than its treatment (Levy, 2012, p. 206). Therefore, an implementation of a vaccination program could minimise the financial impact on the families as well as on the country as whole (Zanetti et al., 2008, p. 6268- 6269; Levy, 2012, p. 206). There have been two programs introduced in relation of minimising hepatitis B infection namely “universal vaccination” and “school-based program” (Gidding et al., 2007, p. 8640; Rots et al., 2010, p. 897). The universal hepatitis B vaccination program was targeted at new born babies who are susceptible to infection from mothers who may carry positive antigens (Rots et al., 2010, p. 894; Levy, 2012, p. 206; Gidding et al., 2007, p. 8637). They are considered to be the most vulnerable of all children’s age groups and the majority of them have a greater risk of having health related issues including chronic hepatitis, cirrhosis and liver cancer (Ni, 2011, p. 2, 5; Rots et al., 2010, p. 894; Levy, 2012, p. 206). The other program assists in improving adolescents’ health owing to the fact that approximately two thirds of adolescents may be identified as a “high risk group” due to their unprotected sexual contacts which could result in development of hepatitis B infection (Gidding et al., 2007, p. 8638; 8640; Rots et al., 2010, p. 894; Van Herck & Van Damme, 2008, p. 861). It is considered that these strategies may protect the health of children and adolescents by controlling the spread of hepatitis B from person to the person (Zanetti et al., 2008, p. 6268; Ni, 2011, p. 5- 6).
It has been highlighted that a number of scheduled hepatitis B vaccinations are required to be administered to children (NCIRS, 2012, p. 4- 5; Rots et al., 2010, p. 894; Zanetti et al., 2008, p. 6267). It is a requirement that the first hepatitis B vaccination is essential to be provided to infants immediately “within twenty four hours after their birth” followed by a further three doses that are given every couple months till six months of their age (Rots et al., 2008, p. 894; WHO, 2013; NCIRS, 2012, p.1, 4). This schedule of vaccinations has dramatically decreased the predisposition for hepatitis B infection from their mother (Rots et al., 2008, p. 894; NCIRS, 2012, p.1, 4). However, with regards to adolescents aged between 11 and 15, the vaccination against hepatitis B is scheduled in two doses with an interval of six months between them (NCIRS, 2012, p. 5; Rots et al., 2010, p. 894). In cases where a child’s immune system is severely compromised by serious health diseases such as obesity or HIV, it is recommended that the administered dose of hepatitis B vaccine should be doubled (NCIRS, 2012, p. 4- 5; Zanetti et al., 2008, p. 6267). To achieve maximum benefit from the vaccination the injections are to be administered in the thigh for the children up to 12 months of age, while those older than that age are required to be administered in deltoid muscle (Zanetti et al., 2008, p. 6267). As the hepatitis B immunisation is usually not contraindicated with the other vaccinations it could be given to children together with the other scheduled vaccinations including diphtheria, tetanus and pertussis (Rots et al., 2010, p. 894). Nevertheless, observation of the children is required due to the possible development of adverse negative reactions of the vaccines (Zanetti et al., 2008, p. 6267).
The effectiveness of hepatitis B vaccination programs is crucial in order to reduce the morbidity of hepatitis B disease together with related liver complications (Rots et al., 2010, p. 897). By measuring the effect of immunisation, it can be determined whether benefits are being achieved or other strategies need to be considered (Ni, 2011, p. 5). The WHO analysis of hepatitis B disease shows that the implementation of hepatitis B immunisation does have a positive effect on the future health of children and adolescents (WHO, 2013). Studies have been conducted to examine the effectivity of implemented vaccination programs along with their financial cost (Gidding et al., 2007, p. 8640; Zanetti et al., 2008, p. 6268). It was found that the “universal vaccination” was highly effective when administering it to children from birth (Roznovsky et al., 2010, p. 398).However, after 10-15 years it offered little protection to the immunised children (Rots et al., 2010, p. 898; Roznovsky et al., 2010, p. 396, 398; Zanetti et al., 2008, p. 6267). Studies showed that the antibodies produced in response to the hepatitis B immunisation are diminished as the adolescents age and this may lead to the development of chronic liver infection (Zanetti et al., 2008, p. 6267). In this case the “school-based programs” are necessary in terms of administering additional doses of hepatitis B vaccination that may assist in protecting child’s health in the long-term, but may be costly for society (Gidding et al., 2007, p. 8640; Rots et al., 2010, p. 898). Additionally, a financial burden may also be associated with the failure of detecting HBV either in mothers or their babies due to insufficient screening (Gidding et al., 2007, p. 8637). Unfortunately, hepatitis immunisation programs which have shown to be very effective for many decades are now in danger of being removed from government agenda (Van Herck & Van Damme, 2008, p. 861).
In summation, the hepatitis B vaccination programs have been very effective as reducing the incidence of disease in society. The corresponding reduction in the burden and impact on families together with reduced costs has been very beneficial. However, because of the success of the vaccination programs they no longer hold the same governmental priorities and may be reduced over time.
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