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Hepatitis B immunisation in Britain: time to change?

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:804
  1. Jangu Banatvala, emeritus professor of clinical virology (,
  2. Pierre Van Damme, director,
  3. Nedret Emiroglu, adviser
  1. King's College London School of Medicine, St Thomas's Campus, London SE1 7EH
  2. WHO Collaborating Centre for Control and Prevention of Viral Hepatitis, University of Antwerp, Belgium
  3. Vaccine Preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark

    The increasing prevalence of chronic infection, mainly due to immigration from endemic areas, may warrant universal immunisation

    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 …

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