Hepatitis B Immunization Strategies: Expanding the Target

Excellent vaccines against hepatitis B infection have been available for a decade but, despite this, the incidence of hepatitis B has increased by 37%.A study by Bloom and colleagues in this issue of the Annals finds that the use of hepatitis B vaccine is cost-effective. Consequently, they support more comprehensive strategies of vaccine delivery. Universal immunization of infants has recently become standard practice. Their recommendation that all 10-year-olds should be immunized as well is sound. However, the immunization of infants and pre-teens will not have a substantial effect on the occurrence of hepatitis B for more than a decade. Therefore, internists must continue to immunize adults in the traditional targeted risk groups, especially sexually active young adults.

Excellent vaccines have been available for the past decade, but the incidence of hepatitis B in the United States has increased by 37% [1]. Approximately 300 000 Americans become infected with hepatitis B virus (HBV) annually, and an estimated 5000 HBV-related deaths from fulminant hepatitis, cirrhosis, or hepatocellular cancer occur each year. Seroepidemiologic studies indicate that about 5% of the U.S. population has been infected with HBV [2].

The paradoxic increase of HBV since the introduction of an effective vaccine reflects the difficulties that stand between the scientific development of a powerful preventive measure and its effective use to achieve the desired individual and societal benefits. After the 1981 licensure of a hepatitis B vaccine with 80% to 95% protective efficacy, guidelines for its use were issued, specific to risk groups defined by occupation, medical conditions, and lifestyle. The implementation of these guidelines has been alarmingly poor for all target groups.

Many reasons have been …