Strategies for prevention of hepatitis B as a sexually transmitted disease

In industrialized western nations where sexual contact is a predominant mechanism of transmitting hepatitis B, benefit:cost models can be developed to indicate when testing of immunity (for susceptibility) would be worthwhile in order to target immunization to high-risk groups and extend the supplies of vaccine. Promiscuous male homosexuals illustrate one end of the spectrum in priority for immunization and screening tests. They are at high risk and at least 50% will be found seropositive for a marker of prior infection and thus do not need immunization. At the other end of the spectrum are populations of typical volunteer blood donors with neither sufficient risk to justify immunization nor a high enough prevalence of seropositive individuals ( less than 10%) to justify screening. An intermediate group, requiring screening tests for selective immunization, would be promiscuous heterosexuals attending venereal disease clinics. Aggressive immunization of sexually promiscuous adults will have major impact in western nations, whereas the newborn must remain the focus of immunization progrmas in areas of the world where hepatitis B virus is endemic.