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Its time for Britain to adopt universal hepatitis B immunization, say senior doctors in an editorial published online by the British Medical Journal.
The United Kingdom is one of the few developed countries that have not implemented universal immunization. Instead, it follows a policy of selective immunization of high-risk groups, and screening all women attending antenatal clinics. But this approach has come in for some criticism. So, is the British selective program effective and should the UK now adopt universal immunization against hepatitis B, ask the authors?
Although the UK has one of the lowest incidences of hepatitis B infection worldwide, the Health Protection Agency estimated that only 44 percent of infections are potentially preventable under the current program.
Of particular importance is the average net immigration of about 6,500 people with chronic hepatitis B infection each year between 1996 and 2000, say the authors. This total is cumulative, and therefore the pool is increasing. For example, in Ireland, the incidence of hepatitis B infection increased markedly between 1997 and 2003, in part reflecting migration from countries with high rates of infection. However, they warn that targeting vaccination at immigrants could be seen as stigmatizing and divisive. Instead, they suggest that, as population movements increase, control of infectious diseases must be supported by regional and global strategies.
Several European countries now include hepatitis B vaccine in their infant immunization programs. Alternatively, vaccinating adolescents has been shown to be acceptable and effective.
Would universal vaccination against hepatitis B in the United Kingdom be too costly? Most cost benefit studies were done before prices were influenced by global markets, say the authors. The full economic burden of hepatitis B still needs to be established but, if direct costs can be reduced by negotiated tendering, there can no longer be a financial argument against adopting a universal immunization strategy against hepatitis B in the United Kingdom, they conclude.
Source: British Medical Journal