Comprehensive control (or elimination) of hepatitis B virus transmission in the United States

In the United States, the reported rate of hepatitis B has declined by over 50% since 1987, probably as a result of vaccination programmes, behavioural changes, refinements in blood screening procedures, and the availability of virus inactivated blood components. The majority of new hepatitis B infections occur in 20-39 year olds, and perinatal transmission is uncommon except in certain at risk groups. Initial efforts to control hepatitis B in the US were targeted at high risk groups, including health care personnel. Then, in 1988, the Centers for Disease Control and Prevention (CDC) recommended screening of all pregnant females for hepatitis B surface antigen and full immunisation of infants born to those testing positive. A recommendation for universal immunisation of infants was endorsed in 1991. Compliance has been slow but progressive. The CDC also has recommended 'catch up' immunisation of adolescents and high risk children and adults. Demonstration projects suggest that these can be successful, given the provision of free or low cost vaccine and appropriate support. Hepatitis B vaccination has been shown to be cost effective and should be integrated into the routine childhood immunisation schedule. Responses to hepatitis B vaccine have largely been shown to be durable, although at least one booster dose after five to 10 years seems prudent, especially if a low dose, yeast derived vaccine has been used.