Top Doctors 2022

The Silent Epidemic: Why Adult Hepatitis B Vaccination In India Can't Wait

When it comes to hepatitis B, most Indians think of the vaccine as something for newborns and infants. Few realise that the virus—highly infectious and potentially deadly—poses an equal, if not greater, risk to adults who have never been immunised. 

And yet, adult vaccination against hepatitis B remains alarmingly low in India, even as the country battles a heavy burden of viral hepatitis and its long-term consequences.

India is home to nearly 40 million chronic hepatitis B cases, according to the World Health Organization (WHO). The virus attacks the liver and, in many cases, progresses silently over decades, ultimately leading to liver cirrhosis, failure, or cancer. What makes hepatitis B especially dangerous is that many infected people remain asymptomatic until irreversible damage is done.

Despite the scale of the problem, adult vaccination coverage remains marginal. "We see a huge gap in awareness and access when it comes to adults," says a public health expert familiar with the National Hepatitis Control Programme. "The universal immunisation programme has helped protect children, but once you cross into adulthood, you're largely on your own unless you're part of a high-risk group."

The hepatitis B vaccine was introduced into India's Universal Immunisation Programme (UIP) in 2002 and expanded nationwide by 2011. Today, it's given to infants in a three-dose schedule beginning at birth. 

Yet, many of those millennials and those adults before them are outside the vaccination net and hence vulnerable to contracting the virus. Especially those adults who fall in high-risk categories, which include healthcare workers, dialysis patients, those with multiple sexual partners, or family members of chronic hepatitis B patients.

Yet, there's little push for catch-up vaccination among adults. Hepatitis B barely features in the adult public health conversation.

Part of the issue is a lack of targeted policy. While the National Viral Hepatitis Control Programme (NVHCP), launched in 2018, aims to eliminate hepatitis B and C by 2030, adult vaccination hasn't received the attention it warrants. 

The programme focuses on screening and treatment of chronic infections and on infant immunisation, but stops short of actively promoting adult vaccination.

This gap leaves millions of adults at risk. As per a 2022 study published in the Journal of Clinical and Diagnostic Research, more than 30% of Indian healthcare workers surveyed were not vaccinated against hepatitis B. Outside of hospitals, the numbers are likely to be even starker.

While a full course of the hepatitis B vaccine is relatively affordable—about ₹100–₹150 per dose in government centres, it is not free for most adults unless they belong to a very specific high-risk group. In rural areas and smaller towns, vaccine access is compounded by logistical challenges and limited awareness among patients.

Dr Ameet Mandot, Director, Department of Hepatology and Liver Transplant Medicine, Gleneagles Hospitals Parel, Mumbai, confirms that many adults fail to get vaccinated for hepatitis B, even though it's important for lifelong protection and well-being. "Lack of awareness and not knowing it's needed after childhood are common reasons behind not taking the vaccine. This gap tends to put many adults at risk of serious liver infection. It is the need of the hour to take the vaccine as recommended by the doctor."

The global health community recognises hepatitis B vaccination as a key strategy to eliminate viral hepatitis. WHO recommends that all unvaccinated individuals should receive the three-dose hepatitis B vaccine series, especially in countries like India, where the disease burden is high. 

The urgency is growing. Hepatitis B remains a leading cause of liver cancer worldwide. According to the paper, 'Global burden of liver disease,' published in PubMed, a medical journal, liver disease accounts for two million deaths annually worldwide, and is responsible for 4 percent of all deaths, that is, 1 out of every 25 deaths worldwide. According to The Liver Foundation, India, HBV is the second most common cause of acute viral hepatitis after HEV in India. With a 3.7% point prevalence, India has over 40 million hepatitis B-infected patients (second only to China) and constitutes about 15% of the entire pool of hepatitis B in the world. 

On this World Hepatitis Day, with the theme 'Hepatitis can't wait', the message is clear: India cannot afford to wait on adult hepatitis B vaccination any longer. 

Awareness drives must move beyond infant immunisation and talk to adults directly, experts tell THE WEEK. Additionally, vaccines must be made easily and freely available in government health centres, not just for infants but also for unvaccinated adults, especially in rural areas.

Hepatitis B may be silent, but India's response to it doesn't have to be. 

WHO Classifies Hepatitis D As Cancer-causing: Why Taking The Hepatitis B Vaccine Helps

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Engerix-B: Uses, Side Effects, Dosage, Interactions, And More

The following are commonly used Engerix-B dosages, but the dosage you receive will be determined by your doctor.

Forms and strengths

Engerix-B comes as a liquid suspension that's given as an injection into a muscle by a healthcare professional. (It may also be given to certain people as an injection under the skin. See the "How it's given" section to learn more.)

Engerix-B is available in the following forms and strengths:

0.5 milliliters (mL) containing 10 micrograms (mcg) per dose, inside a prefilled syringe

1 mL containing 20 mcg per dose, inside a single-dose prefilled syringe or single-dose vial

Recommended dosing schedule

The following is information on dosing schedules recommended by Engerix-B's manufacturer.

Engerix-B dosing schedule for adults

The Engerix-B dosing schedule for adults ages 20 years and older consists of three 1-mL doses given at the following times:

Dose 1: month 0

Dose 2: 1 month after the first dose

Dose 3: 6 months after the first dose

For adults ages 18 and 19 years, the recommended dosing schedule is three 0.5-mL doses given at months 0, 1, and 6.

If you're currently receiving dialysis, you will likely receive four 2-mL doses of Engerix-B given at months 0, 1, 2, and 6. (Each dose is given as two 1-mL injections or one 2-mL injection.) And you might need booster doses in the future, depending on the results of a hepatitis B titer test ordered by your doctor. Your doctor can provide more information, such as how often they'll order a titer test.

Your doctor may recommend a different Engerix-B dosing schedule based on certain factors, such as whether you're traveling to an area with high risk of hepatitis B or whether you've had recent exposure to the virus. Talk with your doctor to learn more about the most appropriate Engerix-B dosing schedule for you.

Engerix-B pediatric dosing schedule

Engerix-B may be given to children of all ages and is considered a safe vaccine for newborns, along with other recommended childhood vaccinations.

The recommended dosage for children is three 0.5-mL doses given as follows:

Dose 1: month 0

Dose 2: 1 month after the first dose

Dose 3: 6 months after the first dose

Your child's doctor may recommend a different Engerix-B dosing schedule based on certain factors, such as plans to travel to an area with high hepatitis B risk. Talk with your child's doctor to learn more about the Engerix-B dose schedule that your child should receive.

How it's given

Engerix-B comes as a liquid suspension that's given as an injection into a muscle by a healthcare professional. You'll receive these injections at your doctor's office, your pharmacy, or a clinic.

For adults and children ages 1 year and older, Engerix-B doses are usually injected into the shoulder muscle. For children less than 1 year old, Engerix-B is typically injected into the thigh muscle.

Engerix-B can also be given as an injection under the skin for people who are at risk of bleeding from an intramuscular injection, such as people with hemophilia. Before receiving Engerix-B, be sure to tell your doctor if you have a condition that increases your risk of bleeding.

Your doctor will explain how Engerix-B will be given to you, including how much you'll be given and how often.

Questions about receiving Engerix-B

The following are some common questions about receiving this vaccine.

What if I miss a dose of Engerix-B? If you miss an appointment to receive a dose of Engerix-B, call your doctor's office, pharmacy, or clinic as soon as possible to reschedule.

Will I need to receive an Engerix-B booster dose? Possibly. In certain situations, an Engerix-B booster dose may be recommended. Talk with your doctor or your child's doctor to learn more, including whether you or your child may need an Engerix-B booster in the future.

How long does Engerix-B take to work? Engerix-B begins to work after you receive your first dose, but it doesn't provide immediate protection against hepatitis B. It typically takes a few weeks for your immune system to create antibodies against the hepatitis B virus. Your doctor may order a hepatitis B titer test to check your antibody level. Talk with them if you'd like to learn more about how to check Engerix-B's effectiveness.

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