Foundation calls for universal hepatitis B vaccination in UK infants

November 27, 2004

BMJ 2004;329:940 (23 October), doi:10.1136/bmj.329.7472.940-g

News extra

London Lynn Eaton

The UK government should meet demands from the World Health Organization and

introduce universal vaccination against hepatitis B for infants, says the

Foundation for Liver Research.

At the moment, the United Kingdom only targets high risk groups for

vaccination, such as healthcare workers, men who have sex with men, sex

workers, and injecting drug users. Babies of infected mothers are also

vaccinated.

The foundation? latest report also calls for better diagnosis and treatment

of the disease. Hepatitis B: Out of the Shadows cites Department of Health

figures, which estimate that there are currently 180 000 people with chronic

hepatitis B in the United Kingdom. Every year a further 7700 people become

infected, according to the Health Protection Agency. But only 1500 patients

are treated for hepatitis B each year.

" If universal [in infancy] and selective vaccination was implemented in the

United Kingdom, as it has been in 150 other countries, this figure [of

incidence] would be significantly reduced and the nation would be better

protected, " said , director of the foundation. The report was

launched in the House of Commons this week.

" We are one of the few countries not to offer universal vaccination, " said

Professor , " The government used to say it was not cost effective

and we didn? have a problem, but the situation is changing. "

The change has in part been due to the influx of people to the United

Kingdom from countries where hepatitis B is more prevalent. And universities

have been accepting more overseas students from countries such as China,

where the incidence in the population is 3-4%, said Professor .

Travellers abroad from the United Kingdom who had not been vaccinated but

had sexual contacts while away also ran the risk of contracting the disease

and bringing it back to the United Kingdom, he added.

To vaccinate all 700 000 children in the United Kingdom at birth would cost

about ?21m ($38m; €30m) a year, since a course of three vaccinations costs

about ?30. The initial costs of a programme to vaccinate all children less

than 5 years old, however, would be about ?105m. The cost of treatment is

about ?3500 for someone in the late stage of the disease.

Without treatment (which includes interferon a , lamivudine, and adefovir

dipivoxil) hepatitis B can eventually lead to liver cirrhosis and cancer.

Professor admitted that he had some involvement with the company

that produces adefovir dipivoxil, although not with the companies producing

the other drugs nor the manufacturer of the vaccine.

Wiersma, medical officer with the World Health Organization, said the

foundation? initiative was exciting news, " Countries with low prevalence

thought they could tackle it best by other strategies, such as safe sex

messages. But it? been shown those strategies are very hard to implement. "

The United States switched from selective vaccination to universal

vaccination of all infants in 1991. Holland is another exception, like the

United Kingdom, which has not adopted universal vaccination.

A spokesperson for the Department of Health said that a working group of the

Joint Committee on Vaccination and Immunisation was currently considering

whether the current immunisation programme for hepatitis B might need to be

strengthened or expanded in future. " No conclusions have been reached yet, "

she said, " But they should finalise their position next year. "

Hepatitis B: Out of the Shadows is available at www.ucl.ac.uk/liver-research

November 27, 2004