The World Health Organization recommended that, by 1997, all countries should introduce a programme of universal immunisation against hepatitis B at birth, in infancy, or in adolescence, according to endemicity.1 By the end of 2005, 168 countries worldwide and 44 of 52 countries in WHO's European region had implemented this. The United Kingdom continues to implement a selective immunisation programme for hepatitis B, targeting high risk groups and screening all women attending antenatal clinics so that the babies of any infected mothers can be immunised at birth. This approach has come in for some criticism, not only internationally but also within the UK.2 Should the UK now adopt universal immunisation against hepatitis B?

In contrast with other European countries, particularly in southern Europe, the UK has one of the lowest incidences of hepatitis B infection worldwide,3 but has about 180 000 people with chronic hepatitis B infection.4 The Netherlands and the Nordic countries, none of which have introduced universal immunisation, also have low rates.5 Is the British selective programme effective?

An …