Introduction

Van Damme and colleagues criticise some European countries for failing to integrate hepatitis B vaccine into national immunisation policies as recommended by WHO. But does their analysis really apply to countries which, like Britain, have hepatitis B virus carrier rates as low as 0.3%1 and report yearly incidences of acute infection of about 1/100 000?2 And is the inclusion of three doses of vaccine in infant schedules, or an attempt to deliver three doses to all adolescents, the most cost effective preventive approach for these countries? We doubt it and suggest that at present it would be preferable to concentrate on reinforcing existing strategies.

The most important step is to stop maternal transmissions of hepatitis B virus, with their high risk of long term carriage developing in the newborn. Thus, in Britain the Departments of Health advise that “antenatal clinics should … consider offering [HBsAg] screening to all antenatal patients” and that neonates born to positive mothers should be fully immunised. Even if, as Van Damme et al suggest, there was a universal immunisation programme for infants, those born to women infected with hepatitis B would still have to be identified and immediately given hepatitis B immunoglobulin or vaccine, or both, at birth, with at least …