A Global Perspective in Controlling Hepatitis B Virus Through Vaccination: A Review With a Focus on Indonesia

Abstract

Even though the universal hepatitis B vaccination program has been conducted in Indonesia since 1997, but until 2018, it has not fulfilled the expected target and tends to experience a decreasing trend. The result of this study was expected to contribute to the government in formulating the best approach to succeed the hepatitis B vaccination program in Indonesia and other countries in the world in the future.The survey of empirical studies and the analysis of articles related to the global perspective in controlling hepatitis B virus through vaccination: a review with a focus on Indonesia.The global prevalence of HBsAg in 2016 was 3.9%. The prevalence of HBsAg in Indonesia in 2016 showed that the population of adults and pregnant women were at risk of being infected with hepatitis B compared to pre-school students and other students. Giving hepatitis B vaccine recombinant in adolescents aged 15-18 years was proven to help give a high immunity and safe along with the decrease in anti-HBs in children after universal vaccination for newborn babies. According to the national immunization policy in Indonesia, the hepatitis B birth dose vaccine should be given within 7 days after the birth and followed by the combination of three vaccines, including diphtheria, pertussis, tetanus, and hepatitis B in 2, 3, and 4 months (DPT-HB3). Both hexavalent (DTaP-HB-Hib-IPV) and pentavalent (DTwP-HB-Hib) vaccines were effective in stimulating anti-HBs ≥10 mIU / ml, and therefore, both of them can be used as a single formula booster at the age of 18 months for simplifying the vaccination. A study identified two dominant genotypes (B and C) among adults in Indonesia. Furthermore, four zones of HBV subtype shared patterns identified in Indonesia: adw, ayw, adr, and mix. The development of vaccines and the detection of mutation passing the diagnostics in the antigenic epitopes in HBsAg will be beneficial for the authority of public health. Further, the diversity of nucleotide levels and amino acids as well as the difference in the proportion of dN/dS in PreS1, PreS2, and HBsAg showed a tendency of selective pressure of non-active status to advanced liver disease. A new policy related to School-Based Vaccination needs to be introduced in Indonesia with a regular medical check-up for vaccination status when registering the school or during elementary school. With an increased number of new vaccines and the dose of vaccine boosters for children targeting school-age students, SBV implementation, and the inspection of students' vaccination records at school can help increase the vaccination coverage.