Conceptual Literature

Local Literature

https://www.unicef.org/philippines/stories/routine-immunization-children-philippines

Hepatitis B virus, is a dangerous liver infection that, when caught as an infant, often shows no
symptoms for decades. It can develop into cirrhosis and liver cancer later in life. Children less than 6
years old who become infected with the hepatitis B virus are the most likely to develop chronic
infections UNICEF Philippines (2021).

According to UNICEF Philippines (2021), vaccines protect children from life-threatening diseases
and save millions of lives each year. For routine vaccines to be effective, it is important that children
receive all of their recommended routine vaccinations on time, starting from birth to one year of age.
They also need to complete additional doses during supplementary or outbreak vaccination campaigns
as announced by the Department of Health. During catch-up immunizations, children who missed any of
their recommended vaccinations should complete them. There must be a minimum of 95% routine
vaccination coverage among children. Routine vaccines are provided by the Government for free in
public health centers and facilities.

The Department of Health has identified routine immunization for children as an essential
health service to prevent the spread and avoid outbreaks of vaccine-preventable diseases. As long as
safety measures and safeguards are taken, the provision of routine immunizations for children under
one year old—including supplemental or catch-up vaccines—continue to be provided throughout the
COVID-19 pandemic.

Foreign Literature

https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

Word Health Organization (2023) stated in this article that Hepatitis B is a major global health
problem. The burden of infection is highest in the WHO Western Pacific Region and the WHO African
Region, where 116 million and 81 million people, respectively, are chronically infected. Sixty million
people are infected in the WHO Eastern Mediterranean Region, 18 million in the WHO South-East Asia
Region, 14 million in the WHO European Region and 5 million in the WHO Region of the Americas.

Hepatitis B is most commonly transmitted from mother to child at birth (perinatal transmission)
or horizontally (exposure to infected blood), particularly between an infected and an uninfected child
within the first five years of life, in highly endemic areas. The development of chronic infection is
common in infants infected from their mothers or before the age of 5 years. Hepatitis B is also spread
through needlestick injury, tattooing, piercing, exposure to infected fluids, reuse of contaminated
needles, and sexual transmission, particularly among unvaccinated individuals with multiple partners.

The hepatitis B virus can survive outside the body for 7 days, causing infection if unprotected. Its
incubation period is 30-180 days, and it can persist and develop into chronic hepatitis B, especially when
transmitted in infancy or childhood. Hepatitis B infection acquired in adulthood leads to chronic
hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic
hepatitis in about 95% of cases. This is the basis for strengthening and prioritizing infant and childhood
vaccination.

The hepatitis B vaccination needs to be given to every newborn as soon as feasible (within 24
hours). This is followed by two or three doses of hepatitis B vaccine at least four weeks apart. Once the
three-dose immunization series has been completed, booster shots are often not necessary. The vaccine
protects against hepatitis B for at least 20 years and probably for life. Transmission of hepatitis
maternally can be prevented by taking antiviral medicines to prevent transmission, in addition to the
vaccine. Liver transplantation is sometimes used in people with cirrhosis or liver cancer in
technologically advanced countries, with varying success.

In low-income settings, most people with liver cancer present late in the course of the disease
and die within months of diagnosis. In high-income countries, patients present to hospital earlier in the
course of the disease and have access to surgery and chemotherapy, which can prolong life for several
months to a few years (WHO, 2023).

Research literature

Foreign

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786543/

In the study of Pley et al., (2021) entitled, “The global impact of the COVID-19 pandemic on the
prevention, diagnosis and treatment of hepatitis B virus (HBV) infection”, HBV is highly endemic in some
of the world’s poorest populations with limited healthcare infrastructure, particularly in sub-Saharan
Africa and Asia Pacific. Just 20 countries account for over 75% of the global burden of HBV. It is
estimated that between 1990 and 2020, childhood vaccination campaigns have prevented 310 million
new HBV infections. Evidence of the effect of the COVID-19 pandemic on the estimated 290 million
people living with chronic HBV (CHB) worldwide has progressively accrued from primary research
studies using physician surveys and routine health system data, with reports that approximately 90% of
viral hepatitis services have been disrupted during the COVID-19 pandemic. Major global public health
interventions will remain essential to curtailing the pandemic, but awareness of broader consequences
is crucial.

Based upon the preliminary data from the Institute for Health Metrics and Evaluation indicates
that the overall global vaccination coverage levels in 2020 have dropped to levels last seen in the 1990s,
threatening 25 years of progress in just 6 months (Gates et al., 2020). After the national emergency was
declared on March 13, 2020, the USA's federally funded "Vaccines for Children" program has recorded
significant drops in vaccine orders and administration; these declines were more pronounced in children
older than 24 months than in younger children, suggesting some success in maintaining routine
vaccination of infants (Santoli et al., 2020). In England, electronic health records have shown that
coverage of the measles, mumps, rubella vaccination dropped by 19.8% when physical distancing
measures were implemented between February and April 2020, compared with the same period in 2019
(McDonald et al., 2020).
 Reduced vaccination coverage may have particularly strong repercussions on HBV incidence in
infancy and early childhood, contributing to an increase in the global burden of chronic infection and
providing a long-term source of onward transmission that threatens progress towards the 2030
elimination goals. The repercussions of the COVID-19 pandemic on HBV vaccination and control may
even outweigh the number of direct COVID-19 deaths in the long term. A recent model has projected
that for one excess COVID-19 death attributable to visiting a vaccination delivery point, mostly in the
older household contacts of children, the deaths of 84 children under 5 years could be prevented if
routine childhood immunization programs were sustained in sub-Saharan Africa (Abas et al., 2020).

Maintenance of HBV immunization is made more difficult by pandemic-related bottlenecks in

the vaccine supply chain, an increases in home births hindering administration of birth dose vaccine,
alterations in the behavior of people seeking medical attention, and potential effects on vaccine
reluctance. While transmission may have decreased due to physical contact and movement restrictions
imposed in many countries, these exceptional circumstances may have also led to an increase in risk
behaviors for HBV transmission, including alcohol and drug use, unprotected sex, reduced anti-viral
treatment availability and increased home births (Gupta et al., 2020).

Vaccination is strongly correlated with both trust in government organizations and fear of the
related disease (Mesch et al., 2019). Both of these factors are labile due to COVID-19. The politicization
of the pandemic has led to a rise in anti-science behavior and mistrust of governments worldwide, even
if risk perception of the threat of infectious illnesses may have grown.

Vertical transmission may also increase as antenatal care services are disrupted and more
women give birth at home, risking an increased burden of CHB among infants born during the pandemic.
Reduced access to interventions for prevention of mother to child transmission (PMTCT) (including
antenatal diagnostics, antiviral therapy, hepatitis B immunoglobulin and vaccine birth doses) endangers
a generation of individuals, who are more likely to develop chronic infection following exposure early in
life. In the long term, such temporary increases in HBV chronic prevalence in the young can contribute
to a positive feedback loop of transmission to subsequent generations (Pley et al., 2021).

Disruption of HBV prevention, diagnosis and treatment services threatens to derail progress
made so far on reducing the global burden of HBV, and pushes the 2030 goal of elimination further out
of reach.