Intended for healthcare professionals


Hepatitis B infections

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:1059

Improving targeted hepatitis B vaccination.

EDITOR--Beeching (1) in relation to the United Kingdom's strategy of
targeting hepatitis B vaccination at various high-risk groups states that
"This has generally failed", before going on to consider uptake among a
number of these groups. In relation to three of these groups - injecting
drug users, men who have sex with men (MSM), and prisoners - he
selectively quotes data that misrepresents the current situation. Whilst
previously levels of vaccine uptake have been low, recent efforts to
increase vaccination rates among these groups have led to substantial

Data from the national Unlinked Anonymous Prevalence Monitoring
Programme Survey of injecting drug users has shown a marked increase in
the proportion of injecting drug users in contact with drug services who
have received one or more doses of the hepatitis B vaccine from only 25%
in 1998 to 50% in 2003 (2). This increase followed the allocation of
extra funding for vaccination of injecting drug users in 1999 (3). Since
2001, the Prison Service has also provided funding for a hepatitis B
vaccination programme, initially in 42 prisons and subsequently extended
to include all reception prisons and young offender institutions. In
2003, 17% (range 0-94%) of new receptions received at least one dose of
vaccine within one month of arriving in prison. A total 14,163 prisoners
received at least one dose of vaccine and 26,265 doses were administered
(4). As part of the national strategy for sexual health and HIV (5), ?1m
was secured for the provision of hepatitis B vaccine to GUM clinics in
England. Data for 2003, indicated that 85% of susceptible MSM were
vaccinated against hepatitis B at first attendance with only 7% refusing
vaccination and 46% of those beginning a course received three doses at
the same clinic (6).

While the debate continues on whether universal hepatitis B
immunisation for either infants or adolescents is needed in the UK,
vaccination of high-risk groups will still be required for the medium
term. The data we have presented above shows that with concerted efforts
the uptake of targeted vaccination can be improved considerably.

1. Nicholas J Beeching. Hepatitis B infections. Editorial. BMJ 2004
329: 1059-1060.

2. Health Protection Agency, SCIEH, National Public Health Service
for Wales, CDSC Northern Ireland, CRDHB, and the UASSG. Shooting Up;
Infections among injecting drug users in the United Kingdom 2003. London:
Health Protection Agency, October 2004 (ISBN: 0 901144 64 9). Available at

3. NHS Executive. Drug Misuse Special Allocation: 1999/2000 Funding
and Guidance on the Modernisation Fund Element. HSC 1999/036.

4. Gilbert RL, Costella A, Piper M and Gill ON (2004). Increasing
hepatitis B vaccine coverage in prisons in England and Wales. Commun Dis
Public Health, in press.

5. The National strategy for sexual health and HIV implementation
plan. London: Department of Health, 2002.

6. Health Protection Agency. 2004. The HepB3 study: hepatitis B
vaccine uptake in men who have sex with men (MSM) attending a GUM clinic
in England as first time attendees. CDR Weekly; 14(40).

Competing interests:
None declared

Competing interests: No competing interests

29 November 2004
Vivian D. Hope
Surveillance Co-ordinator/Research Fellow
Ruth Gilbert, Helen Munro, Fortune Ncube, and O. Noel Gill.
Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ