VHPB: summary of strategies and recommendations. Viral Hepatitis Prevention Board

The Viral Hepatitis Prevention Board (VHPB) believes that stronger action is needed to control hepatitis B. Vaccinating those identified as at 'high risk' has failed to make a significant impact on the epidemiology of the disease. Many people with hepatitis B do not fall into any of the 'classic' high-risk groups and efforts to reach these groups have been unsuccessful. The VHPB supports the recommendation of the World Health Organization (WHO) that hepatitis B vaccine should be incorporated into national universal vaccination programmes by 1997. The recommendation came initially from the Global Advisory Group of the Expanded Programme on Immunization and was endorsed in 1992 by the World Health Assembly, the governing body of WHO which consists of representatives of all WHO member states. The WHO Working Group on the control of viral hepatitis in Europe, which met in Munich in 1991, concluded that the routine immunization of infants and adolescents should receive the highest priority. Universal infant and adolescent strategies have their own benefits and drawbacks; the VHPB has looked carefully into the rationale for and against these strategies. The prerequisites for implementing these strategies are discussed. A combined infant and adolescent strategy emerges as having many of the advantages of the individual approach and fewer disadvantages. Universal vaccination is clearly the most effective strategy for preventing hepatitis B. Its timely and successful implementation, even in countries with medium and low prevalence, is a priority. There is no reason why hepatitis B should not follow the success of smallpox, polio, diphtheria and measles vaccination.