Bui Thi Hong holding her newborn on her lap.

Bui Thi Hong’s baby is protected from hepatitis B thanks to a birth dose of vaccine. Photo: PATH/Pham Trung.

Protecting newborns from hepatitis B

Before she became pregnant, Bui Thi Hong had never heard of hepatitis B. The insidious infection hides in the liver for decades. When it finally manifests, it can be deadly—one in four people infected during childhood die from virus-related conditions like cirrhosis or liver cancer.

In Vietnam’s Hoa Binh Province, where Hong lives, childhood infection rates are high, while prevention—the only recourse—has been dismally low. But with support from PATH and partners, Vietnam’s national immunization program has made tremendous strides in increasing coverage of the lifesaving hepatitis B vaccine. Babies like Hong’s are getting the prevention they need.

A disease spread from mother to child

More than 8 percent of the population of Vietnam is chronically infected with the hepatitis B virus, though most don’t realize it. As in many other endemic countries, mothers commonly pass the virus to their infants during childbirth.

It’s possible to prevent this mother-to-child transmission by giving a dose of vaccine to newborns within 24 hours after birth. The challenge is reaching infants quickly—especially in rural areas where mothers give birth at home or in small health centers that lack refrigeration for storing vaccine.

We address this issue from all angles—influencing national policy, training health workers, and supporting awareness-raising efforts. By working hand-in-hand with local health ministries, we’ve succeeded in expanding birth-dose coverage in Cambodia, India, and Indonesia.

But the situation was especially challenging in Vietnam. In 2006, suspicions that the vaccine was responsible for a number of infant deaths were widely publicized. While an investigation found no link, confidence in the vaccine was lost.

Rebuilding confidence after a scare

In order to get Vietnam back on track with hepatitis B birth-dose vaccination, we worked with national and international partners to restore confidence in the vaccine. We helped Vietnam’s National Expanded Program on Immunization develop a national action plan and technical guidelines for vaccine use. And we educated stakeholders—from government officials to health workers to community members.

Next we piloted our approach in a province with some of the lowest coverage rates in the country. The project trained nearly 1,000 health workers on vaccine use, including safety and storage. We also taught them how to counsel pregnant women, and we broadcast messages through local media to raise awareness of the need for vaccination. In just five months, the vaccination rate jumped from only 20 percent to remarkable 92 percent.

We took the lessons learned from the pilot project and adapted the model for two more remote provinces, including Hoa Binh, where Hong lives. Given the mountainous terrain and the fact that many women give birth at home, getting the message out was difficult. But Hong heard it and knew how to protect her baby. Shortly after she gave birth to her daughter, May, she asked her birth attendant to vaccinate the infant.

Protecting the child and the community

With training provided through the project, health workers are now more confident about explaining the benefits of the birth-dose vaccine and administering it. For Nurse Mai Phuong Thuy, the training was personal as well as professional—her sister has hepatitis B. When Thuy learned that the disease could be passed to infants during childbirth, she encouraged her sister to vaccinate her children and to get yearly health exams.

Thuy realizes that her work is protecting both today’s children and the children of the future, since 90 percent of infants who are born to infected mothers go on to become hepatitis B carriers themselves. “Not only does the vaccination of infants help prevent mother-to-child transmission of hepatitis B,” she said, “it also helps to reduce the transmission rate in the community overall.”

Almost half of the 600,000 hepatitis B-related deaths worldwide every year take place in Asia—but now millions of children in Vietnam and other countries where PATH works are protected from a life sentence with hepatitis B.