Vilnius University Centre of Paediatrics Importance of combined hepatitis B vaccines, point of view of a paediatrician Vytautas Usonis Vilnius University Centre of Paediatrics usonis@ktl.mii.lt

Clinical trials of combined hepatitis-B vaccines in Lithuania DTPw + HBV DTPw-HBV/Hib DTPa-IPV DTPa-HBV DTPa-HBV-lPV HAB

Antigens given at the first year of life Diphtheria Tetanus Pertussis (Pw Pa) Polio (OPV IPV) Hepatitis-B Hemophilus influenzae-B Pneumo- Meningo-

Burden of VH-B VH-B is the only vaccine preventible disease which can be transmitted vertically Risk of prenatal and intranatal transmission of infection has an impact on the immunisation strategy

Primary infants immunisation: Three doses of the VH-B vaccine Different strategies, depending on the prevalence of hepatitis-B first dose at birth first dose at the age of 2-3 months

First dose of the VH-B vaccine at the age of 2-3 months Countries with low incidence of VH-B Countries with high incidence of VH-B where the universal maternal screening is implemented: high coverage of the universal maternal screening immunisation of newborns is available

First dose of the VH-B at the age of 2-3 months HBV/1 HBV/2 HBV/3 1 6 2-3 3-4 Age months DTP/1 DTP/2 DTP/3 IPV/1 IPV/2 Hib/1 Hib/2 Hib/3

HBV/1 HBV/2 HBV/3 DTP/1 DTP/2 DTP/3 IPV/1 IPV/2 Hib/1 Hib/2 Hib/3 1 6 2-3 3-4 Age months

DTPw based combinations DTPw-HBV DTPw-HBV-Hib DTPw-HBV-Hib-IPV (?) Pw is the most reactogenic component parents’ concern regarding reactogenicity of Pw adverse events interchangibility of Pw and Pa containing vaccines

DTPa based combinations DTPa-HBV DTPa-HBV-Hib DTPa -HBV-Hib-IPV Good compliance, high safety, high effectiveness, but: high costs

First dose of the VH-B vaccine at birth Countries with high or moderate incidence of VH-B where the universal maternal screening DOES NOT exist: selective screening of ‘risk groups’ of pregnant women is not reliable with no maternal screening programmes - focus on universal neonatal immunisation vaccination of new-born infants is as effective as passive/active immunisation (HBIg+vaccine)

HBsAg-positive mothers should not be discouraged from breast-feeding

First dose of the HBV vaccine at birth The schedules most widely used are 0,1,6 or 0,1,2,12 months, both of which are effective HBV/1 HBV/2 HBV/3 1 6 2-3 3-4 Age months BCG DTP/1 DTP/2 DTP/3 IPV/1 IPV/2 Hib/1 Hib/2 Hib/3

Forthcoming antigens Pneumo-conjugate Meningo-conjugate

New vaccines Hib PnC McC + DTPa HBV IPV OR DTPa HBV IPV Hib PnC McC