The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies
Alter, M.J.; Hadler, S.C.; Margolis, H.S.; Alexander, W.J.; Hu, P.Y.; Judson, F.N.; Mares, A.; Miller, J.K.; Moyer, L.A.
JAMA 263(9): 1218-1222
1990
ISSN/ISBN: 0098-7484 PMID: 2304237 Document Number: 353301
Hepatitis B virus infection, being transmitted by routes identical to HIV, is a convenient surrogate marker of risk behaviour within the population. This important paper looks at rates of HBV infection in the years 1981-88 in 4 counties spread over the USA. The incidence of acute HBV infection remained unchanged at 13.2/100 000 population/year in the 2 million people studied. A falling incidence in homosexual men and health-care personnel has been balanced by a rise in i.v. drug users and heterosexually-acquired disease. [This, as the authors suggest, shows that only universal application of hepatitis B vaccination can hope to make an impact on the disease incidence. Of more concern to me is the evidence that public education has failed to reduce risk behaviour for HIV infection in heterosexuals and drug users.]M.G. Brook.