Children in the UK and seven other European countries should be universally vaccinated against hepatitis B to eliminate the major public-health impact of this disease, according to a Review published in the June issue of The Lancet Infectious Diseases.

Infection with hepatitis B causes between 500,000 and 1.2 million deaths per year worldwide, with around 22,000 of these deaths occurring across Europe. Hepatitis B is also the leading cause of liver cancer.

Dr Jane Zuckerman, Academic Centre for Travel Medicine and Vaccines, Royal Free and University College Medical School, London, UK and colleagues reviewed vaccination policies in the UK, Ireland, Finland, Iceland, the Netherlands, Norway, Sweden, and Denmark.

They say: Over 12 years ago, WHO recommended that universal childhood hepatitis B vaccination be implemented globally. Despite this, Denmark, Finland, Iceland, Ireland, the Netherlands, Norway, Sweden, and the UK adopt an at-risk strategy.

At-risk vaccination programmes mean only those people at the highest risk of contracting the disease, e.g. immigrant communities, are vaccinated.

The authors add: Although all eight countries are classed as having low endemicity, factors such as increased travel and integration of immigrant communities are increasing the number of at-risk individuals in these countries.

Under-reporting of hepatitis B cases is a problem, even in industrialised countries. The authors say: The annual incidence of hepatitis B in England is reported to be 600 cases. However, over the past four years, the true incidence is thought to have been nearer 6,000 cases, mainly because of immigration of hepatitis B-positive individuals from areas of high endemicity.

The Review also examines the role of drug users, short- and long-haul travellers, and tattoos and body piercing.

The authors say that the advantages of a universal vaccination programme include that it is the
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Contact: Dr. Jane Zuckerman
j.zuckerman@medsch.ucl.ac.uk
44-779-887-6445
Lancet
5-Jun-2007