To curb the increased prevalence of hepatitis B among young people, a panel of experts convened by the Society for Adolescent Medicine (SAM) is recommending universal hepatitis B immunization for that at-risk age group.
"The agreement among leading experts that all adolescents should be vaccinated [against hepatitis B] is an important step in dealing with this serious health issue," said SAM president Richard Brookman, M.D. Brookman served as moderator for the roundtable discussion, which was supported through a grant from SmithKline Beecham.
Hepatitis B is spread by means of blood and other body fluids; the most common mode of transmission is through sexual contact. The disease can also be spread by percutaneous or permucosal routes and from mother to child during birth.
According to the Centers for Disease Control & Prevention (CDC), individuals at highest risk of acquiring hepatitis B are pesons with more than one sexual partner in six months, those with occupational exposure to blood products, IV drug abusers, and persons living with hepatitis B carriers.
Although an effective vaccine has been available since a 1982, hepatitis B infection is still a major public health concern, affecting an estimated 300,000 Americans each year. Seventy-five percent of all cases occur in individuals between the ages of 15 and 39. Persons acutely infected with hepatitis B may go on to develop a chronic form of the disease, which is associated with liver cirrhosis and liver cancer.
William Schaffner, M.D., explained that when the hepatitis B vaccine was introduced in the early 1980s, vaccine programs targeted high-risk adults. "But the high-risk approach doesn't work," Schaffner said. "We used to think about finding subpopulations in the general population who were at specific higher risk of acquiring hepatitis B than others. This thinking is a nonstarter, and it sime ply doesn't work," he said.
"The disease is always someone else's disease, and it's difficult for physicians to find those people at high risk," he noted. Schaffner, who is chairman, department of preventive medicine, Vanderbilt University, and professor of infectious diseases, department of medicine at Vanderbilt University School of Medicine, added that the high-risk approach is further hampered by the fact that in about one-third of all cases, a risk factor is not found.
Panelists noted that in adolescents, a population where the source of hepatitis B infection is unknown in 60% of cases, the high-risk approach has been ineffective in curbing the spread of the disease. …