Notice to Readers
Update: Recommendations to Prevent Hepatitis B Virus Transmission
-- United States
In October 1994, the Advisory Committee on Immunization
Practices (ACIP) approved recommendations expanding the vaccination
strategy to eliminate hepatitis B virus (HBV) transmission in the
United States. These recommendations include:
Vaccination of all unvaccinated children aged less than 11
years who are Pacific Islanders or who reside in households of
first-generation immigrants from countries where HBV is of high or
intermediate endemicity.
2. Vaccination of all 11-12-year-old children who have not
previously received hepatitis B vaccine.
Reported by: Epidemiology and Surveillance Div, National
Immunization Program; Hepatitis Br, Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: In November 1991, the ACIP recommended that
hepatitis B vaccine be integrated into infant vaccination schedules
(1). However, high rates of HBV infection continue to occur among
children aged 0-10 years who are Alaskan Natives, Pacific
Islanders, and infants of first-generation immigrant mothers from
areas where HBV infection is of high or intermediate endemicity.
Among children in these populations, the prevalence of chronic HBV
infection ranges from 2%-5%, and infection rates average 2% per
year (2,3). These infections occur in children born to women who
are hepatitis B surface antigen-negative and account for a large
proportion of the chronic HBV infections that occur each year in
the United States. Of the estimated 1 million Asian and Pacific
Islander children aged 2-10 years in the United States, less than
10% have received hepatitis B vaccine. Special efforts should be
made to ensure hepatitis B vaccination of these populations because
of their high risk for chronic HBV infection and death from
HBV-related chronic liver disease.
Routine infant hepatitis B vaccination is the most effective
means to prevent HBV transmission in the United States. The effect
of routine infant vaccination on acute disease incidence may not be
apparent for 20-30 years because currently most infections occur
among young adults. Vaccination of previously unvaccinated children
at age 11-12 years should result in a more rapid decline in the
incidence of HBV infection. However, adolescent hepatitis B
vaccination should not supplant vaccination of infants, because
routine infant hepatitis B vaccination would eventually eliminate
the need for adolescent and adult vaccination.
Vaccination recommendations are most effective when they
become integrated into routine health care. Although preventive
health services and vaccination visits for adolescents are not well
established in the United States, hepatitis B vaccination of this
age group has been successful in settings including schools and
clinical practices (4,5). The ACIP has recommended that hepatitis
B vaccination of adolescents be done as part of a routine
adolescent vaccination visit at age 11-12 years. This visit should
be used to ensure that all adolescents have received three doses of
hepatitis B vaccine, two doses of measles-mumps-rubella vaccine, a
booster dose of tetanus and diphtheria toxoids, and to assess
whether adolescents are immune to varicella. The establishment of
an adolescent vaccination visit provides the opportunity to deliver
preventive health-care services to this underserved population.
References
Mahoney FJ, Lawrence M, Scott K, Le Q, Lambert S, Farley T.
Continuing risk for hepatitis B virus transmission among Southeast
Asian infants in Louisiana. Pediatrics (in press).
Hurie MB, Mast EE, Davis JP. Horizontal transmission of
hepatitis B virus infection to United States-born children of Hmong
refugees. Pediatrics 1992;89:269-73.
CDC. Hepatitis B virus: a comprehensive strategy for eliminating
transmission in the United States through universal childhood
vaccination -- recommendations of the Immunization Practices
Advisory
Committee (ACIP). MMWR 1991;40(no. RR-13).
CDC. Hepatitis B vaccination of adolescents -- California,
Louisiana, and Oregon, 1992-1994. MMWR 1994;43:605-9.
Kollar LM, Rosenthal SL, Biro FM. Hepatitis B vaccine series
compliance in adolescents. Pediatr Infect Dis J 1994;13:1006-8.
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