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Universal childhood hepatitis B vaccination: infants vs. preadolescents, the Canadian perspective
1Vaccine Evaluation Center, British Columbia's Children's Hospital, Vancouver, Canada.
Background:
In the 1980s, populations of the United States and Canada exhibited similar and increasing incidence of hepatitis B. Vaccination programs targeted at high risk populations did not impact on overall disease incidence.
Methods:
Hepatitis B immunization strategies in the United States and Canada were reviewed to determine their impact on vaccination coverage. To reduce the transmission of hepatitis B, divergent vaccination plans emerged within North America. The United States added hepatitis B to its universal infant immunization schedule, and Canada implemented hepatitis B immunization programs for preadolescents (9 through 13 years of age).
Results:
To date, both strategies have markedly increased vaccination coverage among the targeted cohort. Hepatitis B vaccination coverage of infants rose from 8% in 1992 to 82% in 1996 in the United States. In Canada, hepatitis B vaccine uptake rates among preadolescents have been high, with all major provinces reporting near or greater than 90% coverage in 1996.
Conclusions:
The incidence of acute and chronic hepatitis B in Canada should drop measurably within the decade as these protected preadolescents move into adulthood. In addition, the Canadian vaccine delivery infrastructure allows for the addition of new vaccines targeted for adolescents.