Hepatitis B: time for a universal childhood vaccination programme?

Editorial Team

Editorial Team

August 19th, 2013

Editorial Team

Hepatitis-BAbout 14 million people in the European region are chronically infected with hepatitis B virus, according to the WHO. But debate continues as to whether hepatitis B vaccination should be included in childhood immunisation programmes in every country.

Although there is a general decreasing trend, each year there are between 7,000 and 8,000 new cases diagnosed with hepatitis B in the EU. Experts want to accelerate this reduction but there is no consensus on the best way to tackle the problem.

Experts on both sides of the argument lined in up a recent Head to Head debate in the British Medical Journal to debate whether universal immunisation or a targeted approach is the best way forward.

Hepatitis B is potentially life-threatening as it increases the risk of liver cirrhosis and liver cancer. It is most prevalent in Asia and Africa where more than 10% of the population is said to be chronically affected in some countries.

While the infection is often transmitted through contact with contaminated body fluids such as semen,blood or through contaminated instruments (surgical, dental, tattooing, needles used forintravenous drugs), the origin of the infection remains unknown in 30% of cases.

About one third of the world’s population has been infected at some point in their lives resulting in some 350 million chronic hepatitis B carriers, according to the WHO.

Universal vaccination

Hepatitis B can effectively be prevented by vaccination. Safe and effective HBV vaccines have been available since the 1980s and are 95% effective in preventing chronic infection.

In their BMJ piece advocating universal hepatitis B vaccination, Professor Pierre Van Damme and colleagues at the University of Antwerp in Belgium, wrote that while 47 of the 53 countries in the WHO European Region have universal hepatitis B vaccination, Iceland, the UK, Denmark, Norway, Sweden and Finland have not.

Instead, those countries only vaccination those believed to be at risk. This, say Van Damme and colleagues, is rarely as effective as a universal approach and can prove more difficult to implement because target groups include commercial sex works and injecting drug users.

They also highlight the increasing number of immigrants to Western Europe from countries with higher rates of the disease.

Targeted approach

But TuijaLeino and colleagues from the National Institute of Health and Welfare in Finland disagree. They note that in countries with low or very low prevalence, infection is normally a result of “risky behaviour” by young adults.

As immigration is by far the main source of new carriers in countries with low hepatitis B rates, a universal childhood vaccination programme for the local population would have minimal effect.

“Preventative efforts are therefore better directed elsewhere,” they argue.

According to the Finnish group, antenatal screening of pregnant women for the hepatitis B virus is the key to identifying carriers and reducing the number of newborn babies who get the disease from their mother. Indeed infection in newborns often leads to chronic carriage and complications later in life.

What do you think?