HEPATITIS-B VACCINATION - WHAT ARE THE CURRENT INTERNATIONAL RECOMMENDATIONS

Hepatitis B is one of the world's most common and serious infectious d iseases with around 350 million chronic carriers worldwide. Many carri ers will die of chronic liver disease, cirrhosis or hepatocellular car cinoma. An estimated 1 million people worldwide die of hepatitis B eac h year. Safe and effective vaccines against hepatitis B became commerc ially available in the early 1980s. Initially in limited supply and ve ry expensive, hepatitis B vaccines are now readily available and very much closer in price to other infant vaccines. Strategies for immunisa tion of selected high risk groups alone have not been shown to be effe ctive in controlling hepatitis B infection, even in developed countrie s with a low incidence of infection. In 1992, the World Health Assembl y recommended that all countries with high levels of hepatitis B preva lence should implement universal infant hepatitis B immunisation progr ams by 1995, and that all other countries should do so by 1997. An inc reasing number of countries are adopting policies of universal immunis ation, usually infant immunisation integrated with the routine immunis ation schedule. In some countries, supplemental or catch-up immunisati on of older children or adolescents is also being carried out. Importa nt practical issues in relation to hepatitis B immunisation are: (a) v accine and service delivery costs; (b) the place of prevaccination scr eening 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 poli tical will and the lack of committed resources. Combination vaccines i ncorporating hepatitis B, particularly diphtheria/tetanus/pertussis/he patitis B, are likely to facilitate the universal vaccination that is necessary for global control of this important disease.