Reply

Abstract

10 October 2001 Dear Editor REPLY Dr Thies is correct that there are economic arguments against the birth dose of hepatitis B vaccine in Australia, a country of low endemicity. However, these arguments assume that selective vaccination of high-risk neonates is well implemented. An effective control strategy must focus on preventing chronic carriage, as chronic carriers are the main reservoir of infection.1 The risk of carriage is inversely proportional to age, with neonates being at highest risk of becoming carriers.2 A vaccination programme for newborns will have a much greater impact on carriage rates than one at 2 months of age because the risk of chronic carriage is highest (up to 90%) in the neonate. Dr Thies states that he has found ‘no evidence’ of poor implementation of selective programmes, but does not provide any references to support this lack of ‘evidence’. I can only assume he is speaking anecdotally. There are studies from several countries that do provide evidence that vaccination of neonates born to carrier mothers is variably implemented, and that completion of the full schedule of vaccination is poor.3-5 In addition, antenatal screening for hepatitis B, despite the existence of screening policies, is variable.3 Provider factors can have a significant impact on vaccine uptake.3 Although it is quite reasonable (and desirable) to question and evaluate policy, it is unhelpful when providers send mixed messages about national vaccination policy to their patients. The bottom line is that global eradication of hepatitis B cannot be achieved with selective vaccination. The same rationale lies behind the need for continued universal vaccination against poliomyelitis in Australia, despite a very low risk in this country. It is interesting that resistance by health professionals to universal polio vaccination does not seem as prevalent as that towards the hepatitis B vaccine.