Britain should adopt universal hepatitis B immunisation

Britain should adopt universal hepatitis B immunisation, says a senior doctor in this week's BMJ.

The United Kingdom is one of the few developed countries that have not implemented universal immunisation. Because the burden of hepatitis B was low and individual rights were considered paramount, a policy of selective immunisation of high-risk groups, such as health care workers, homosexual men, and drug addicts, has been followed.

However, this approach has failed to provide adequate coverage in Britain and should be replaced by universal immunisation, writes Nicholas Beeching of the Royal Liverpool University Hospital.

The hepatitis B virus causes up to a million deaths worldwide every year. In the United Kingdom, 4,500 acute hepatitis B virus infections, 7,500 new cases of chronic infection, and up to 430 cases of hepatitis B related liver cancer are thought to occur, with estimated NHS costs of up to £375m.

The availability of effective and safe vaccines makes primary prevention of hepatitis B an attractive strategy. Universal immunisation has been adopted by over 150 countries, with evidence of effectiveness lasting more than 10 years in preventing infection, carriage, and liver cancer.

In light of this evidence, it is time that Britain's policy was reviewed, he concludes.