most effective means of reducing the global burden of a particular disease. It also protects children before they are at risk of infection, and vaccines available today can immunise individuals for life with no need for additional booster vaccinations. Disadvantages include cost-effectiveness in countries of low endemicity and concerns about adding another vaccine into the childhood vaccination programme.

The advantages of the at-risk strategy are that an immediate impact within the target group can be obtained, with low cost in countries with low endemicity. Disadvantages include leaving the general population at risk, the difficulties in properly identifying at risk groups and the social stigma of being defined at-risk.

The authors conclude that on the basis of current experience and evidence, the UK, Ireland, Finland, Iceland, the Netherlands, Norway, Sweden, and Denmark should all adopt a universal vaccination policy.

They say: Global hepatitis B universal vaccination is ultimately the only way to eliminate HBV transmission and new cases of hepatitis B. Indeed, global efforts to control and prevent hepatitis B are of crucial importance and it is the responsibility of each country worldwide to play its part.

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Contact: Dr. Jane Zuckerman
j.zuckerman@medsch.ucl.ac.uk
44-779-887-6445
Lancet
5-Jun-2007


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