Myths and Challenges in Hepatitis B Vaccination- Experience at Tertiary Care Centre of Northern India

Background: Globally, hepatitis B is a serious health concern. As a component of universal immunisation, the hepatitis B vaccine is both economical and effective, with few adverse effects. Hepatitis B vaccine side effects include headache, exhaustion, low-grade fever, and discomfort, redness, or swelling at the injection site. The aim is to identify misconceptions and difficulties related to the hepatitis B vaccination. Material and Methods: Over the course of five and a half years, from October 1, 2020, to April 30, 2026, the Department of Medical Gastroenterology at the Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, undertook this prospective study. The study only included the 5,000 individuals who received three doses of 20 micrograms (1 millilitre) of hepatitis B at intervals of 0, 1, and 6 months. Among the 5,000 study participants that tested negative for hepatitis B, 1200 were medical professionals, 1000 were HCV patients, and 2800 were relatives of Hepatitis B patients. The challenges in getting them vaccinated with full three doses were registered. The reasons in those who were advised vaccination but refused for the same were also recorded. Results: 1200 healthcare professionals, 1000 HCV patients, and 2800 relatives of Hepatitis B patients made up the study group's total of 5,000 participants. Each received three dosages. In respect to health care workers because of belonging to same field there were no apprehensions regarding side effect of vaccination but there was laxity in some for getting vaccination. The most important challenge on family screening was in getting screened and vaccinated against HBV in married daughters of that family. It is common belief that females who got married are living at distance from parental family, hence, no chances of getting HBV infection. They do not appreciate, the importance of vertical transmission from the mothers to children in family. The other challenge faced was in certain husbands of HBV infected females, majority of these husbands were typical Indian males with strong ego and were alcoholic. They felt, that they do not need advice of their spouses, as they are main head of family. Many patients who were married and living in nuclear family have not shared with brother, sister or parents of having HBV infection, hence there was strong resistance in getting them screened and vaccinated against HBV. One more ethical issue and challenge noticed in young males and females who were going to get married, was hiding of their HBV infection from the person whom they were going to get married. In this whole family of HBV patient who was getting married was on same page of hiding this information to the counterpart. They had fear of break-up in the marriage. They agreed to getting screened and vaccinated their counterpart on pretext of health grounds. The other challenge associated with HBV vaccination was confusion with covid vaccine. On enquiring from the family members of HBV patient, that they have been vaccinated for HBV, they replied in affirmative but on deep probing, it was learnt that they were confusing it with covid-19 vaccine. We always advise, as per protocol to take vaccine in arm, patient again replied in affirmative, that they have already been vaccinated in childhood in arm but on detailed evaluation, it was found to be BCG vaccination against tuberculosis. Most of recipients will take first two dose but there are chances of missing the third dose because it has to be given after a gap of six months. Conclusion: India is having intermediate prevalence of HBV. Hepatitis B vaccination is strongly indicated in health care workers and high -risk groups. Hence, myths and challenges associated with it have to be appreciated and removed, so as to pass benefit of same to the needy population.

Keywords: Hepatitis B virus; Hepatitis B Vaccination, Challenges, Marriage, Family Screening.