Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States

There is a global epidemic of hepatitis B virus (HBV) infections affecting more than 350 million people worldwide. This collective review provides the rationale for a comprehensive strategy to eliminate transmission of HBV in the United States. The virologic characteristics of HBV include three forms of HBV surface antigen (HBsAg), HBV core antigen (HbcAg), as well as a circulating peptide, the HBV e antigen (HBeAg). The year 2002 was the 20th anniversary of the use in the United States of the world's first vaccine against HBV. Our prevention strategy involves making HBV vaccine a part of the routine vaccination schedules for all infants in the United States. Hepatitis B immune globulin (HBIG) is another useful adjunct for prophylaxis that provides temporary protection (i.e., 3-6 months) and is recommended in only certain postexposure settings. The routes for administration of HBV vaccine and HBIG are intramuscular sites that differ according to the age of the individual. Following routine HBV vaccination in adults and children, prevaccination and postvaccination serologic testing is not recommended because of the relatively low rate of HBV infection and the low cost of the vaccine. Postexposure prophylaxis for HBV with serologic testing is, however, necessary for all hospital personnel exposed to blood or body fluids. In addition, infants born from mothers not immunized to HBV or those who are infected with HBV also require comprehensive postexposure prophylaxis with serologic testing. Comprehensive immunization strategies with serologic testing must be implemented for all groups that have a high risk of HBV infection. Finally, vaccine information statements (VIS) must be carefully integrated in this comprehensive disease prevention strategy, which is designed to prevent the transmission of HBV in the United States.