Hepatitis B vaccine uptake amongst at-risk infants: Experience from a dedicated inner city clinic

Abstract

Hepatitis B (HBV) is a vaccine-preventable disease of global public health importance. According to the World Health Organization (WHO), England and Wales have been categorized as low-prevalence countries [hepatitis B surface antigen (HBsAg) prevalence less than 2%]. Chronic carriage is most likely to result from childhood infection; 90% of those born to HBsAg-positive/ hepatitis B e antigen (HBeAg)-positive mothers will be chronically infected, although transmission is significantly reduced in HBsAgpositive/HBeAg-negative mothers. In high-prevalence areas, childhood acquisition either perinatally or through horizontal transmission is common. However, in the UK, an estimated 12% of new chronic infections result from perinatal infection and the risk of infection is heterogeneously distributed, determined mainly by adult risk factors such as intravenous drug abuse. Amongst childhood infections, mother to infant, household transmission and exposure overseas are commonly reported. The efficacy of a primary course of hepatitis B vaccine in preventing HBV infection in children is well established, and the success of routine childhood immunization in interrupting HBV transmission has been well demonstrated. Despite the WHO recommendation to adopt universal infant immunization against HBV by 1997, some low-endemicity countries including the UK have adopted a selective policy of immunizing at-risk infants (those born to mothers who are HBsAg and/or HBeAg positive) using an accelerated schedule. Vaccination is offered at 0, 1 and 2 months, with a booster dose administered at 12 months. Infants born to HBeAg-positive mothers are also offered hepatitis B