In October 1997, the Advisory Committee on Immunization
Practices
(ACIP) expanded its hepatitis B vaccination recommendations to
include all
unvaccinated children aged 0-18 years and made hepatitis B vaccine
available through the Vaccines for Children program (VFC) for
persons aged
0-18 years who are eligible for VFC. ACIP priorities for hepatitis
B
vaccination of children remain unchanged and include all infants;
children
in populations at high risk for hepatitis B virus (HBV) infection
(e.g.,
Alaska Natives, Pacific Islanders, and children who reside in
households of
first-generation immigrants from countries where HBV infection is
moderately or highly endemic); previously unvaccinated children
aged 11-12
years; and older adolescents and adults in defined risk groups.
In 1991, the ACIP recommended a comprehensive hepatitis B
vaccination
strategy to eliminate HBV transmission in the United States (1).
Critical
elements of this strategy include preventing perinatal HBV
transmission by
identifying and providing immunoprophylaxis to infants of hepatitis
B
surface antigen-positive mothers and universal hepatitis B
vaccination of
infants to interrupt transmission. In 1994, the ACIP expanded the
recommendations to include previously unvaccinated children aged
11-12
years (2). The percentage of children aged 19-35 months who have
received
three doses of hepatitis B vaccine has increased substantially from
less
than 10% in 1991 to 84% in 1997 (3). No nationwide vaccine coverage
data
are available to assess vaccine coverage among children aged 11-12
years;
however, vaccine coverage in this group is expected to increase in
states
that have implemented middle school entry requirements for
hepatitis B
vaccination (4).
To increase access to hepatitis B vaccine, the new
recommendations
encourage vaccination of previously unvaccinated children and
adolescents
aged 0-18 years whenever they are seen for routine medical visits.
This
expansion of the recommended age group for vaccination and for VFC
eligibility simplifies previous recommendations and the eligibility
criteria for VFC vaccine. Providers should ensure that vaccination
records
of children and adolescents presenting for vaccination are checked
for
receipt of previous doses.
Universal vaccination of infants and children aged 11-12 years
will
result in a highly immune population and is expected to eliminate
HBV
transmission in the United States. However, high rates of HBV
infection
continue to occur among Alaska Native and Pacific Islander children
and
among children residing in households of first-generation
immigrants from
countries where HBV infection is endemic (5,6). As a result,
targeted
programs are needed to achieve high vaccination coverage among
these
children. In addition, because most HBV infections in the United
States
occur among adults, vaccinating infants and adolescents aged 11-12
years
alone will not substantially lower disease incidence for several
years.
Most HBV infections in adults occur among persons who have defined
risk
factors for HBV infection, including persons with multiple sex
partners
(more than one partner during the preceding 6 months); men who have
sex
with men; and injecting-drug users (7). The primary means to
prevent these
infections is to identify settings where adolescents and adults
with
high-risk drug and sexual practices can be routinely accessed and
vaccinated (e.g., sexually transmitted disease clinics,
family-planning
clinics, drug-treatment clinics, community-based human
immunodeficiency
virus prevention sites, and correctional facilities).
References
CDC. Hepatitis B virus: a comprehensive strategy for
eliminating
transmission through universal childhood vaccination:
recommendations
of the Immunization Practices Advisory Committee (ACIP). MMWR
1991;40(no. RR-13):1-20.
CDC. Update: recommendations to prevent hepatitis B virus
transmission
United States. MMWR 1995;44:574-5.
CDC. National, state, and urban area vaccination coverage
levels among
children aged 19-35 months -- United States, 1997. MMWR
1998;47:547-54.
CDC. Effectiveness of a seventh grade school entry vaccination
requirement -- statewide and Orange County, Florida, 1997-1998.
MMWR
1998;47:711-5.
Hurie MB, Mast EE, Davis JP. Horizontal transmission of
hepatitis B
virus infection to United States-born children among refugees.
Pediatrics 1992;89:269-73.
Mahoney FJ, Lawrence M, Scott K, Le Q, Farley T. Continuing
risk for
hepatitis B virus transmission among children born in the
United States
to southeast Asian children in Louisiana. Pediatrics
1995;95:1113-6.
CDC. Hepatitis surveillance report no. 56. Atlanta, Georgia: US
Department of Health and Human Services, Public Health Service,
CDC,
1995.
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