Time for Britain to adopt universal hepatitis B immunisation

Editorial: Hepatitis B immunisation in Britain: time to change? BMJ online first

It's time for Britain to adopt universal hepatitis B immunisation, say senior doctors in an editorial published online by the BMJ today.

The United Kingdom is one of the few developed countries that have not implemented universal immunisation. Instead, it follows a policy of selective immunisation of high-risk groups, and screening all women attending antenatal clinics.

But this approach has come in for some criticism. So, is the British selective programme effective and should the UK now adopt universal immunisation against hepatitis B, ask the authors?

Although the UK has one of the lowest incidences of hepatitis B infection worldwide, the Health Protection Agency estimated that only 44% of infections are potentially preventable under the current programme.

Of particular importance is the average net immigration of about 6,500 people with chronic hepatitis B infection each year between 1996 and 2000, say the authors. This total is cumulative, and therefore the pool is increasing.

For example, in Ireland, the incidence of hepatitis B infection increased markedly between 1997 and 2003, in part reflecting migration from countries with high rates of infection.

However, they warn that targeting vaccination at immigrants could be seen as stigmatising and divisive. Instead, they suggest that, as population movements increase, control of infectious diseases must be supported by regional and global strategies.

Several European countries now include hepatitis B vaccine in their infant immunisation programmes. Alternatively, vaccinating adolescents has been shown to be acceptable and effective.

Would universal vaccination against hepatitis B in the United Kingdom be too costly?

Most cost benefit studies were done before prices were influenced by global markets, say the authors. The full economic burden of hepatitis B still needs to be established but, if direct costs can be reduced by negotiated tendering, there can no longer be a financial argument against adopting a universal immunisation strategy against hepatitis B in the United Kingdom, they conclude.

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