Reduction in the hepatitis B related burden of disease--measuring the success of universal immunisation programs

There is collective evidence from countries of both low and high endemicity that administration of hepatitis B vaccination at birth saves lives and reduces the burden of disease from acute and chronic infection. However, a discussion on the cost-effectiveness of vaccination for HBV is beyond the scope of this article. In Australia, longer term follow-up of HBV disease burden is required following the more recent introduction of routine and universal infant vaccination. Universal vaccination for HBV at birth can be seen as a 'safety-net' against infection at a very young age. However, it is estimated that the effect of universal infant vaccination will not be evident for at least another 15 years in Australia. The obstacles to vaccination with HBV, which have historically included fears that the vaccine may be linked to multiple sclerosis, should be put to rest, and concerns about the thiomersal content allayed by communicating the current availability of thiomersal-free vaccines to all providers and parents or care-givers. Furthermore, ongoing adverse events surveillance should be in place to detect any rare adverse events which may be related to the vaccine. Currently, more than one half of the world's infants are still not being immunised for HBV, and the need for a global initiative for universal infant hepatitis B vaccination is apparent. This is especially true for countries with high prevalence, and the costing issues and logistics of such an initiative still remain to be addressed. In addition, there is a need to address the implementation of guidelines for screening and vaccination of families who have immigrated to Australia from countries with a high prevalence of hepatitis B.