Elsevier

Vaccine

Volume 21, Issues 1–2, 22 November 2002, Pages 1-4
Vaccine

Meeting report
Hepatitis B vaccination: how to reach risk groups

https://doi.org/10.1016/S0264-410X(02)00440-1Get rights and content

Abstract

Current hepatitis B vaccination programmes targeting risk groups have met with little success in controlling HBV infection in the general population. Despite the long-standing existence of unambiguous recommendations for risk-group vaccination, hepatitis B vaccination coverage remains low in most risk groups in most high-income countries. This low coverage may be attributed to a lack of perceived risk of hepatitis B and the absence of appropriate health care programmes targeting hepatitis B monitoring and vaccination for certain risk groups, particularly sex workers, injecting drug users, and prisoners. The Viral Hepatitis Prevention Board (VHPB) recognises the importance of raising the awareness of health care providers, policymakers, and the general public, about hepatitis B as a risk to both the community in general and to specific groups considered at increased risk. The VHPB also recognises that new strategies will have to be developed and implemented.

Introduction

Hepatitis B virus (HBV) is one of the world’s most widespread infectious agents. Approximately 400 million persons worldwide are chronic carriers, with evidence of actual or past infection in over two billion people [1]. In 1992, the World Health Organisation (WHO) recommended that all countries introduce universal hepatitis B vaccination into their national immunisation programmes by December 1997 [2], [3]. One hundred and thirty-five countries have since complied with the recommendation.

The risk of contracting hepatitis B infection is associated with a number of factors relating to one’s lifestyle, living conditions, occupation, and overall health and well-being [4]. HBV transmission occurs perinatally, i.e. from infected mother to infant, horizontally, sexually, or parenterally. On a worldwide basis, most infections are transmitted from an infected mother to her child, through child-to-child household contacts, and through re-use of unsterilised needles and syringes.

Section snippets

Risk groups

In industrialised countries, HBV is transmitted primarily through parenteral and sexual exposure to HBsAg-positive blood or other body fluids (which contain high concentrations of the virus) from persons who are chronic HBV carriers or have acute hepatitis B. Those at highest risk of HBV infection include:

  • injecting drug users;

  • persons who engage in unsafe sexual behaviour, such as heterosexuals with multiple sex partners, men who have sex with men, persons attending sexually transmitted

Hepatitis B vaccination coverage

Hepatitis B vaccination programmes targeting risk groups appear to have met with little success in controlling HBV infection in the general population [6], [7]. Despite the long-standing existence of unambiguous recommendations for risk-group vaccination, hepatitis B vaccination coverage remains low in most risk groups in most industrialised countries. The low coverage may be attributed to a combination of factors relating to: (a) lack of perceived risk of hepatitis B, not only among members of

How to reach risk groups

The Viral Hepatitis Prevention Board (VHPB) recognises the importance of raising the awareness of health care providers, policymakers, and the general public, about hepatitis B as a risk to both the community in general and to specific groups considered at increased risk. This implies that clear and consistent messages regarding the benefits of hepatitis B vaccination should be transmitted to these target groups. In addition, low-risk sites, such as community health and family planning centres,

Recommendations

Based on presentations and discussions, the VHPB formulated a number of specific considerations and recommendations for each of the risk groups, as summarised below.

References (7)

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On behalf of the Viral Hepatitis Prevention Board (VHPB). The VHPB organised an expert meeting on hepatitis B vaccination and risk groups in Ghent, Belgium, on 15–16 March 2001. Participants: Selim Badur, Turkey; Koye Balogun, UK; Joseph Barry, Ireland; Elizabeth Boxall, UK; José de la Torre, Spain; Antoon De Schryver, Belgium; Monique Elseviers, Belgium; Nedret Emiroğlu, Denmark; Emmy Engelen, Belgium; Guido François, Belgium; Jean-François Gehanno, France; Marsha Ginson, France; Peter Grob, Switzerland; Nicole Guérin, France; Robert A. Gunn, USA; Johannes Hallauer, Germany; Luc Hessel, France; Daniel Lavanchy, Switzerland; Rudolf Mak, Belgium; Eric Mast, Switzerland; André Meheus, Belgium; Georges Papaevangelou, Greece; Anne-Marie Plesner, Denmark; Colette Roure, France; Daniel Shouval, Israel; Robert Steffen, Switzerland; Diana Steimle, Belgium; Pierre Van Damme, Belgium; Bernard Van den Broecke, GSK; Jim van Steenbergen, The Netherlands; Alex Vorsters, Belgium; Robert Vranckx, Belgium.

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