[VACCINATION AGAINST HEPATITIS B: WHAT'S UP?]

The vaccination against hepatitis B has been shown to be effective and safe. 15 years after a scare suggesting a relationship between the HBV vaccine and the development of demyelinating diseases, studies have not confirmed this suspected link. The french HBV vaccination strategy in effect since the 1990's (vaccination of newborns, a catch-up campaign in children and adolescents and vaccination of high risk populations) is well adapted to the existing epidemiological situation. Vaccination coverage in newborns has increased significantly since 2008. Catch-up of children and adolescents is insufficient. The very limited data on vaccination coverage in populations at high risk of HBV suggests that coverage is largely insufficient. The mandatory vaccination of healthcare workers since 1991 has nearly completely eradicated worksite HBV. Nevertheless: persistent circulation of the virus and the risk of healthcare worker-patient transmission, and insufficient coverage justifies continued vaccination and mandatory proof of immunization. Specific vaccination protocols are needed because certain co-morbidities can reduce the probability and strength of the response to the vaccine. The physician should evaluate this risk case-by-case and adapt the vaccination protocol accordingly. Between 2007 and 2012, more than 200 patients have undergone liver transplantation associated with HBV (cirrhosis, hepatocellular carcinoma, fulminant hepatitis). Many of these transplantations could have been avoided thanks to vaccination, and these grafts could have been proposed to other patients.