Britain needs a standardised nationwide universal screening programme

Acute hepatitis B is becoming much less common in Britain now that blood and blood products are safe, health care staff are being vaccinated, infectious health care workers are being steered away from procedures that could transmit the virus, drug misusers have needle exchange schemes, and sexually active people have counselling and condoms. The current morbidity and mortality from hepatitis B mostly result from the chronic carrier state,1 and the prevention of persistent infection must be central to any strategy to control the virus and its effects.

The probability that infection with hepatitis B will become persistent decreases with the age at which infection occurs. Between 60% and 90% of babies born to the most infectious mothers (those positive for hepatitis B e antigen) become carriers if infected perinatally, whereas this happens to less than 10% of those people infected as adults.1 2 3 Perinatal infection can be prevented by prompt administration of immune prophylaxis at birth,4 5 and the prevention of perinatal infection in this way will have a substantial impact on the numbers of carriers in the future.

The Netherlands is one of Britain's closest neighbours in Europe, and its population includes immigrants from other …