1. Vilnius University Centre of Paediatrics
Importance of combined hepatitis B vaccines, point of view of a paediatrician
Vytautas Usonis
Vilnius University Centre of Paediatrics

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

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

4. 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

5. 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

6. 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

7. 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

8. HBV/1 HBV/2 HBV/3 DTP/1 DTP/2 DTP/3 IPV/1 IPV/2 Hib/1 Hib/2 Hib/31 6
2-3
3-4
Age
months

9. 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

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

11. 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)

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

13. 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

14. Forthcoming antigens
Pneumo-conjugate
Meningo-conjugate

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