The hepatitis B virus causes up to a million deaths worldwide and 16 million healthcare related infections in the tropics every year.1 2 In the United Kingdom, 4500 acute hepatitis B virus infections, more than 7500 new cases of chronic infection with hepatitis B virus (mainly in immigrants), and up to 430 cases of hepatitis B virus related hepatocellular carcinoma are estimated to occur each year, with estimated NHS costs alone of £26m-£375m ($48m-686m;€37m-538m) per year.3 Approaches to prevention and treatment of hepatitis B have been reviewed in this issue and elsewhere (p 1080).1^–5 Vaccination and the implications of new screening and treatment strategies for carriers of hepatitis B virus in the Britain are discussed here. Immunisation strategies targeting multiple risk groups have failed to provide adequate coverage in Britain and should be replaced by universal immunisation.

Most deaths from hepatitis B virus are due to chronic carriage (presence of virus for more than six months), leading to inflammation, cirrhosis, and cancer of the liver. Since most infections in the tropics occur perinatally or in early childhood, …