Abstract
Policies for hepatitis B immunization in Canada and the USA evolved from 1982 and culminated in recommendations for universal vaccination in both countries in 1991. In policies developed between 1982 and 1985 there were clear national recommendations for the immunization of selected risk groups, e.g. healthcare workers, recipients of multiple blood products, infants of HBsAg-positive mothers and those at high risk for sexual transmission. By 1988, both countries had policies for prenatal screening. It is evident that most vaccine was delivered to healthcare workers and that the epidemiology of the disease did not change as a result of selective strategies. However it is very important, for the foreseeable future, to continue selective immunization programmes in addition to a universal strategy in order to protect those presently at risk.
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