Rajasthan Government has recommended in 2011 that hepatitis B vaccination be given to all institutional delivered babies within 24 hrs of birth as 0 dose so as to prevent vertical transmission. The remaining recommended doses are to be given at 6-10-14 weeks. IAP Immunization Schedule 2009-10 recommended five schedules viz. birth, 1 and 6 months; birth, 6 and 14 weeks; 6, 10 and 14 weeks; birth, 6 weeks, 6 months; and birth, 6 weeks,10 weeks, 14 weeks. The recent Consensus Recommendations of IAPCOI [1] has recommended the 0-6wks-6months schedule, the first dose to be administered at birth, second dose at 6 weeks and third dose at 6 months. The reason being it is more closer to immunologically ideal and most widely used 0-1-6 months schedule, and also conforms to latest ACIP recommendations wherein the final dose in the Hepatitis-B vaccine series should be administered no earlier than 24 weeks and at least 16 weeks after the first dose [2] .

Therefore, the question arises as to the rationality of the recommendation followed in the above 4-doses schedule, wherein the first dose is given within 24 hours of birth for institutional deliveries only. With these, we will be missing out on those delivered outside the hospital and also those coming for vaccination beyond 24 hours of birth even in case of hospital deliveries also which happen many a time. If on the other hand if it is beneficial, should we recommend it?

As to the other schedules where 6-10 weeks schedule are also included, should we altogether forgo it ,despite the programmatic implications and logistic issues as it is not ideal immunologically and does not conform to the classical schedule of 0-1-6 months.

Coming back to the schedule followed here, where the birth-6-10-14 weeks are recommended, and based on what we have noted above, it is far from being ideal. First, the ‘Zero’ dose benefits only a section of a population and deprives those newborns delivered outside and also those of institutional deliveries presenting after 24 hours of life. Secondly, the schedule with its recommended dose at 10 and 14 weeks dose not conform to the ideal immunological response and schedule as recommended under ACIP guidelines [2]. So what should be the further course to be taken here in the context mentioned above.

1. Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus guidelines on recommendations on immunization,2008.Indian Pediatr. 2008;45:635-48.