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Hepatitis B Vaccination

Hepatitis B is a serious infectious disease which affects the liver. It is caused by the hepatitis B virus (HBV) which is estimated to be 100 times more infectious than HIV, the virus which causes AIDS. Chronic hepatitis B is difficult to treat. The only treatment currently available is effective only in a proportion of patients, has significant side effects and is expensive.

A vaccine exists which can prevent the spread of hepatitis B. The vaccine is effective and has only minor side effects. Currently the vaccine has to be administered in three separate doses. The disease is easier to prevent than treat and could largely be eliminated through vaccination.

Each year approximately 1 million people die world-wide from the acute and chronic sequelae of HBV infection making it one of the major causes of morbidity and mortality to man. Worldwide more people die each year from hepatitis B than from AIDS. In 1992 the World Health Organisation recommended that countries implement universal immunisation of all pre-adolescents, or of all infants by 1997.

Today more than 80 countries have taken up the World Health Organisation recommendation. The UK does not have a plan to implement a universal vaccination programme against hepatitis B and is out of step with international thinking in this regard.

In 2000 the Department of Health introduced antenatal screening for hepatitis B. Those mothers found to be hepatitis B positive are counselled and their baby offered an accelerated schedule of vaccination at 0, 1 and two months with a booster at 12 months.

The UK has adopted a selective vaccination strategy. The programme has largely failed, although offering good protection to those who have been vaccinated. The vaccination strategy for low endemnicity areas has failed because it is delivered to groups that only represent a small percentage of reported cases.

In the UK there are areas with a higher prevalence of hepatitis B infection within the population. This is particularly so amongst ethnic groups from regions of the world with a high prevalence of hepatitis B. Increase of foreign travel and an increase in cross-cultural socialisation in the UK will increase the spread of the infection. In the UK the major mode of infection is through sexual transmission. It is therefore the 15 to 25-year-old population who are at greatest risk of HBV infection in the UK. This is a time of experimentation for this age group and it is to this population that a vaccination programme needs to be targeted. Whilst targeting adolescents seems a viable proposition, and would be supported by CLDF there are clear practical difficulties.

A simpler and more effective solution would be to universally vaccinate all infants against hepatitis B. The infrastructure is in place to administer such a programme with a success rate of vaccination in excess of 90% of all babies. The added benefit would be to protect infants born to mothers with acute or chronic HBV infection during pregnancy. Such infants have up to a 90% chance of becoming a chronic carrier. Whist this is not a major mode of transmission in the UK it must not be forgotten.

Failure to put in place a universal vaccination programme will have serious long-term repercussions. In the short term the reservoir of carriers will silently increase particularly amongst those aged 15 - 25 years of age. In ten to twenty years time the UK will suffer the consequences of failing to protect the nation's children by an increase in the number of cases of liver cirrhosis and hepatocellular carcinoma due to the long latent phase of the disease. This will have a major resource impact on the health service at that time. In a disease that can be prevented through vaccination, all that is required is the political will to effect change by implementation of the WHO recommendation. The Government today has a responsibility for the health of future generations.

The Children's Liver Disease Foundation recommends the implementation of a policy of universal infant vaccination against hepatitis B.