HEPATITIS-B VACCINATION - WHAT ARE THE CURRENT INTERNATIONAL RECOMMENDATIONS

Hepatitis B is one of the world's most common and serious infectious diseases with around 350 million chronic carriers worldwide. Many carriers will die of chronic liver disease, cirrhosis or hepatocellular carcinoma. An estimated 1 million people worldwide die of hepatitis B each year. Safe and effective vaccines against hepatitis B became commercially available in the early 1980s. Initially in limited supply and very expensive, hepatitis B vaccines are now readily available and very much closer in price to other infant vaccines. Strategies for immunisation of selected high risk groups alone have not been shown to be effective in controlling hepatitis B infection, even in developed countries with a low incidence of infection. In 1992, the World Health Assembly recommended that all countries with high levels of hepatitis B prevalence should implement universal infant hepatitis B immunisation programs by 1995, and that all other countries should do so by 1997. An increasing number of countries are adopting policies of universal immunisation, usually infant immunisation integrated with the routine immunisation schedule. In some countries, supplemental or catch-up immunisation of older children or adolescents is also being carried out. Important practical issues in relation to hepatitis B immunisation are: (a) vaccine and service delivery costs; (b) the place of prevaccination screening and post-vaccination serological testing; (c) vaccine and host factors that can reduce the immunological response to vaccination; (d) the management of nonresponders; and (e) the duration of protection. The key obstacles to achieve universal childhood immunisation are political will and the lack of committed resources. Combination vaccines incorporating hepatitis B, particularly diphtheria/tetanus/pertussis/hepatitis B, are likely to facilitate the universal vaccination that is necessary for global control of this important disease.