Enhanced surveillance of acute symptomatic hepatitis B in England and Wales

A prospective incidence study was used to estimate the effect on transmission of hepatitis B virus (HBV) in England and Wales of maximising uptake of HBV vaccination in patients at risk attending genitourinary medicine (GUM) clinics or any medical services. Laboratory based surveillance in 1993 gave an incidence of acute symptomatic hepatitis B of 1 case per 100,000 population. Transmission through sexual intercourse was twice as common as through injecting drug use. Less than 20% of patients with acute HBV infection had attended a GUM clinic before their illness, but 42% had had access to other medical services where vaccination could have been offered routinely. Sixty per cent of patients' sexual partners and 37% of other members of their household had been offered vaccination. Compared with universal infant or pre-adolescent vaccination, extending the current selective policy to all who attend GUM clinics or any medical services would have a limited impact on the incidence of HBV, particularly as uptake of three doses of vaccine in adults is likely to be low.