Elsevier

Clinics in Liver Disease

Volume 20, Issue 4, November 2016, Pages 607-628
Clinics in Liver Disease

Epidemiology of Hepatitis B Virus Infection and Impact of Vaccination on Disease

https://doi.org/10.1016/j.cld.2016.06.006Get rights and content

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Key points

  • The Global Advisory Group of the Expanded Programme on Immunization recommendations to integrate hepatitis B vaccination into national immunization programs have resulted in substantial reductions of hepatitis B virus (HBV) transmission in previously high endemic countries.

  • A 68% decrease in HBV infection prevalence among US children, regardless of country of origin, was observed within 10 years of initiation of universal hepatitis B vaccination.

  • The key strategy for control of the HBV epidemic

Transmission of hepatitis B virus

There are 2 major modes of transmission of HBV that occur in the world. Perinatal transmission, occurring at birth from infected mothers to their newborns, accounts for the majority of HBV transmission worldwide. Horizontal transmission can occur through open cuts and scratches; transfusion of blood products; breaks in good practices to prevent blood-borne infections in the health care setting; sexual transmission and risky behavior, including injecting-drug use or tattooing, body piercing, and

Strategies for control and prevention of hepatitis b infection

This article discusses the good practice principals that can effectively halt transmission of HBV. It uses as examples global and US programs in HBV vaccination (eg, Alaska) to demonstrate how effective infant vaccination strategies can accomplish this goal, starting with the first dose of hepatitis B vaccine administered immediately after birth followed by full vaccination during infancy and the use of catch-up vaccination programs for children. In addition, it highlights how programs

United States Vaccine Policy

In the United States in 1991, the Advisory Committee on Immunization Practices (ACIP) published a comprehensive strategy for eliminating transmission in the United States through universal childhood. The strategy included recommendations for the prevention of perinatal HBV infection, universal vaccination of infants born to HBsAg-negative mothers, vaccination of adolescents, and vaccination of selected high-risk groups.37 The recommendations have been revised and expanded since 1991.

United States Universal Infant and Childhood and Adult Vaccination Policy

The 2005

Impact and Current Status of Implementation of World Health Organization Recommendations

The 1991 EPI recommendations for universal hepatitis B vaccine at birth and other hepatitis B vaccination strategies have resulted in substantial reductions of HBV transmission in previously high endemic countries.2 In 2014, global coverage with 3 doses of hepatitis B vaccine is estimated at 82% (compared to 1% in 1990) and is as high as 92% in the Western Pacific.1 For example, the national Taiwan vaccine program, which started in 1984, has been 78% to 87% effective in reducing HBsAg

Challenges in Implementation of Birth Dose Vaccination in Low-Income and Middle-Income Countries

There are several reasons why many low-resource countries are having difficulty implementing birth dose vaccination within 24 hours of birth. These include:

  • 1.

    Out-of-hospital births are common in countries with high HBV endemicity, and home deliveries are frequently handled by traditional birth attendants, most of whom have no formal training.

  • 2.

    In many resource-limited settings, particularly in Africa and Asia, HBV vaccine is only available in a pentavalent preparation (with diphtheria, pertussis,

Summary

The hepatitis B vaccine which has been proven to be safe and effective with protection after the vaccine series estimated to persist for at least 30 years among greater than 90% of persons vaccinated,74 is a key component of chronic hepatitis B prevention and eventual elimination. Routine infant vaccination in over 180 countries has resulted in a reduction in global HBV transmission and declines in chronic HBV prevalence.1, 2 Particular success in reduction of HBV burden from high to low

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    Disclosure: Drs Nelson and McMahon have nothing to disclose. Dr Easterbrook: The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

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