Indian Pediatr 2009;46: 1013-1015
Timing of Zero Dose of OPV, First Dose of
Hepatitis B and BCG Vaccines
Thomas A Kuruvilla and Akila Bridgitte
From Sundaram Medical Foundation, Dr Rangarajan Memorial
Hospital, Anna Nagar West, Chennai,
Tamil Nadu, India.
Correspondence to: Dr Bridgitte Akila, Senior
Registrar-Epidemiology, Sundaram Medical Foundation,
Dr Rangarajan Memorial Hospital, Anna Nagar West, Chennai 600 040, Tamil
Manuscript received: January 21, 2008;
Initial review: March 3, 2008;
Accepted: March 18, 2009.
Published online: 2009 July 1.
The Indian Academy of Pediatrics has been
recommending Hepatitis B vaccination for infants since 1992. This
community based cross sectional study carried out in the rural and urban
areas of Tamil Nadu found no significant rural urban difference in the
proportions of children who had received BCG in 3 days/7 days and OPV-zero
dose in 3 days/7 days after birth. The proportion of children who had
received first dose of Hepatitis B in 3 days was significantly lower
than those who had received BCG and OPV within 3 days after birth. The
proportion of children who had received Hepatitis B on the day of birth
was significantly lower in the rural area than in the urban area.
Key words: BCG vaccine, Hepatitis B Vaccine,
Immunization, India, OPV.
ndian Academy of Pediatrics
recommends universal Hepatitis B vaccination for infants, starting with
zero dose at birth(1). Tamil Nadu has recently introduced hepatitis B
immunization as part of its universal vaccination strategy, wherein all
infants receive BCG, OPV and hepatitis B at birth. This paper analyzes the
rural urban difference in the timing of the first dose of hepatitis B, OPV
and BCG vaccines among infants in Tamil Nadu.
A community-based cross-sectional study using cluster
sampling method was undertaken in the selected parts of rural Thiruvallur
district and urban Chennai to estimate the routine and the newer childhood
vaccines coverage rate among children aged 12-24 months. The urban study
area comprised of lower, lower middle, middle, upper middle and upper
class socioeconomic groups. While the selected rural population was
approximately 35,000 (50 villages), the urban population was approximately
1,56,174 (excluding slum areas)(2). The sample size was 202 for the rural
and 205 for the urban study. Interviewers were trained for data collection
and their interviewing techniques were standardized before the data
collection. During the study, we collected information on the dates of
zero dose OPV and the dates of BCG and the first dose of hepatitis B
vaccines from the immunization card and from mothers, if immunization card
was not available. We calculated the cumulative percentage of children
receiving these doses by age of receipt (in days). We compared the
following between the rural and the urban areas: (i) timeliness of
BCG and OPV-zero dose, and (ii) the percentage of children who had
received hepatitis B at birth. Dates of BCG, OPV zero dose and the first
dose of hepatitis B vaccine were obtained from the immunization card for
95%, 95%, 92.1%, and 46.3%, 47.3%, 69.6% of the urban and the rural
The BCG and the Hepatitis B coverage rates were 99% and
74.6% in the rural areas and 100%, 95.7% in the selected urban areas,
respectively. The cumulative percent distribution of the children by the
age of receipt (in days) of) BCG, OPV-zero dose and the first dose of
Hepatitis B vaccine for both the rural and the urban study population are
shown in Table I. The proportion of children aged 12-24
months who had received BCG on the day of birth and OPV-zero dose within 3
days after birth were 3% and 55.9%, respectively, in both the rural and
the urban areas. The proportion of children who had received Hepatitis B
on the day of birth was 3.5% and 11% in the rural and urban areas,
Cumulative Percent Distribution of Children Who Had Received BCG, OPV Zero Dose and First Dose of
Hepatitis B Vaccine by Age of Receipt (in Days) in Rural and Urban Tamil Nadu
Time of vaccine
||Hepatitis B-first dose
| 0 day
This cross sectional study provides information on the
proportion of children who had received BCG vaccine, OPV zero dose and the
first dose of Hepatitis B vaccine by age of receipt (in days) of these
vaccines. No significant rural-urban difference was observed in the
proportion of children having received BCG on the day of birth, in 3 days,
in 7 days and in 14 days after birth. Similarly, no significant rural
urban difference was observed in the proportion of children receiving OPV
on the day of birth, in 3 days and in 7 days after birth. However, in the
rural area, the proportion of children received OPV on the day of birth
(7.9%) was significantly higher (P=0.03) than those received BCG on
the day of birth (3%). The availability of the dates of these vaccines for
a very high proportion of the urban study children and a substantial
proportion of the rural study children adds validity to the findings of
The proportion of children who had received the first
dose of Hepatitis B on the day of birth was significantly lower in the
rural area than in the urban area (P=0.04). One of the probable
reasons is that urban mothers undergo screening test for HBsAg positivity
and children born to HBsAg positive mothers receive the first dose of
Hepatitis B on the day of birth. It was also observed the proportion of
children who had received Hepatitis B in 3 days after birth was
significantly lower than those who had received BCG in 3 days and OPV in 3
days after birth in both the rural and the urban areas. This reduction in
proportion of children who received the first dose of Hepatitis B vaccine
at birth is due to the availability of different dose schedules for infant
Hepatitis B vaccination.
HBsAg positivity among mothers is reported to be very
low but the efficacy of the first dose of Hepatitis B at birth among
children born to HBsAg positive mothers is well understood in other
settings(3). Antenatal care providers in general and general
physicians/obstetricians in particular should keep mothers informed
regarding the availability of HBsAg test and infant Hepatitis B
vaccination including dose schedules. This would further increase the
proportion of children receiving the first dose of Hepatitis B at birth.
The observed high acceptability of Hepatitis B vaccines in the urban and
the rural study population gives hope for the success of this strategy.
Dr Arjun Rajagopalan, Trustee and Medical Director of
Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai for
support; and, Dr Jayaprakash Muliyil, Head, Community Health, Christian
Medical College, Vellore for comments.
Contributors: BA: Concept, design and implementing
the study, supervising the data collection, data entry and analysis and
preparing the manuscript. TK: Concept, design, data analysis and
preparation of manuscript.
Funding: Sundaram Medical Foundation.
Competing interests: None stated.
What This Study Adds?
• Proportion of children receiving hepatitis B vaccine within 3
days of birth is significantly lower than those receiving OPV or BCG
1. Indian Academy of Pediatrics Committee on
Immunization (IAPCOI). Update on immunization policies, guidelines and
recommendations. Indian Pediatr 2004; 41: 239-244.
2. Directorate of Census Operations-Tamil Nadu: Primary
Census Abstract-Census 2001. Available from: URL: http://www.census.tn.nic.in/pca2001.
aspx. Accessed March 30, 2008.
3. Mele A, Tancredi F, Romano L, Giuseppone A, Colucci
M, Sangiuolo A, et al. Effectiveness of hepatitis B vaccination in
babies born to hepatitis B surface antigen-positive mothers in Italy. J
Infect Dis 2001; 184: 905-908.