Delivering vaccine to infants at risk is complex

Editor—In their commentary on Pierre Van Damme and colleagues' paper Philip P Mortimer and Elizabeth Miller suggest a phased approach to the delivery of a childhood hepatitis B immunisation programme in Britain.1 Initially this would involve stringent implementation of the current programme of universal antenatal screening and subsequent tracking and delivery of vaccine to infants at risk.

In April 1994 Lambeth, Southwark, and Lewisham Health Authority commissioned a community based computer assisted tracking system for following up infants at risk.2 Existing community nursing and medical staff were trained in delivering the programme. Apart from covering the costs of the vaccine and of initial software, no new money was made available. Universal antenatal screening was operational by April 1995. The health authority covers an area of wide ethnic diversity (white 58.0%, West Indian 17.9%, African 12.5%, Asian 6.8%.). There are about 12 500 births a year; the prevalence of positivity for hepatitis B surface antigen on antenatal screening is …