The effectiveness of the infant hepatitis B immunisation program in Fiji, Kiribati, Tonga and Vanuatu

The aims of this project were: (1) to determine the extent to which infant hepatitis B immunisation is preventing chronic hepatitis B infection in chi ldren living in a sample of Pacific Island countries; and (2) to identify f actors associated with the successful prevention of hepatitis B infection i n these populations. A regional hepatitis B immunisation project which supp lied hepatitis B vaccine to 10 Pacific Island countries began in 1995. Sero epidemiological surveys were conducted in Fiji, Kiribati, Tongs and Vanuatu in early 1998. These included immunised pre-school children and their biol ogical mothers, and a historical control group of unimmunised students. Pre valence rates for hepatitis B surface antigen (HBsAg) in the populations of students, mothers and their pre-school children were respectively: Fiji: 6 .9, 6.6, 0.7%; Kiribati: 27.4, 15.1, 3.8%; Tonga: 11.1. 18.6, 3.8%; Vanuatu : 16.3, 12.31 3.0% and for all four countries: 13.2, 12.5, 2.6%. Compared t o the historical control group of students, the pre-school population had a much lower probability of HBsAg positivity (relative risk [RR]=0.19 [95% C I: 0.12-0.31]). Statistically significant differences in risk were apparent for all the countries: Fiji: RR=0.10; Kiribati: RR=0.14; Tonga: RR=0.34; V anuatu: RR=0.19. This is equivalent to an overall program effectiveness of 81% (95% CI: 69-88%) in reducing chronic carriage. Also, the overall protec tive effectiveness against vertical hepatitis B transmission resulting in H BsAg positivity among children exposed to HBeAg positive and negative carri er mothers, was estimated to be 70%. By age 6 months, when all children sho uld have had three vaccine doses, completed immunisation rates ranged from 22 (Fiji) to 84% (Vanuatu). Coverage of the first dose being given within 2 days of birth varied from 43% in Kiribati to 92% in Tonga. In conclusion h epatitis B immunisation of infants in these four countries is having a subs tantial beneficial effect in preventing chronic hepatitis B infection. Neve rtheless, there is significant scope for further improving the timeliness o f immunisation. (C) 2000 Elsevier Science Ltd. All rights reserved.