EPIDEMIOLOGIC REPORTS * ETUDES EPIDEMIOLOGIQUES
Universal vaccination against hepatitis B Since hepatitis B vaccine was licensed in Canada in 1982 its use has been restricted to selected high-risk groups.' This strategy has been effective in controlling the disease in health care workers. However, other high-risk groups, including those that account for most cases of hepatitis B, have been difficult to reach.2 Furthermore, 35% of cases of acute hepatitis B occur in people without any recognized risk factor; in these, heterosexual contact seems to play a major role in the transmission of the disease. Over the past 10 years the reported incidence rate of acute hepatitis B in Canada has progressively increased, from 5 to 13 cases per 100 000 population, despite the introduction of vaccine.3 Analysis of passive surveillance data suggests that the epidemiologic profile of hepatitis B in Canada is similar to the one seen in the United States. Data from an intensive surveillance program established in four US sentinel counties have also failed to show any major impact of vaccination on the occurrence of acute hepatitis B.2 There is an emerging consensus among experts in the field that universal vaccination during childhood is the key to the control of hepatitis B in North America.4 The Canadian Paediatric Society, the
American Academy of Pediatrics and the US Immunization Practices Advisory Committee have recently called for universal vaccination of children.5 After reviewing the evidence the National Advisory Committee on Immunization has concluded that to achieve significant control of hepatitis B in Canada universal vaccination should be implemented. This is in addition to the present strategy for high-risk groups. However, such outstanding issues as the cost of the vaccine and optimal scheduling need to be resolved before a specific program can be recommended.
References 1. Statement on hepatitis B vaccine. Can Di.s Wkly Rep 1982; 8: 221-224 2. Alter MJ, Hadler SC, Margolis HS et al: The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies. JAMA 1990; 263: 1218-1222 3. Hepatitis B in Canada: surveillance summary, 1980-1989. Can Dis Wkly Rep 1991; 17: 166-171 4. Hollinger FB and the North American Regional Study Group: Controlling hepatitis B virus transmission in North America. Vaccine 1990; 8 (suppl): S 122-S128 5. Marwick C: Hepatitis B vaccine appears headed for pediatric immunization schedule. JAMA 1991; 265: 1502
Based on material previously reported in Canada Diseases Weekly Report (a publication of the Bureau of Communicable Disease Epidemiology, Laboratory Centre for Disease Control [LCDC], Department ofNational Health and Welfare, Tunney's Pasture, Ottawa, Ont.) by the National Advisory Committee on Immunization (NACI): Drs. Susan E. Tamblvn (chairman), medical officer of health, Perth District Health Unit, Stratford, Ont.; Jacqueline A.K. Carlson, physician manager, Disease Control and Epidemiology Service, Ontario Ministry ofHealth, Toronto, Ont.; John Conly, head, Division of Infectious Diseases, Royal University Hospital, Saskatoon, Sask.; Gilles Delage, Department ofMicrobiology and Immunology, Hopital Sainte-Justine, Montreal, Que.; Pierre Dery, chefdu Service des maladies infectieuses, Departement de pediatrie, Centre hospitalier de l'Universite Laval, Sainte-Foy, Que.; John Furesz, director, Bureau of Biologics, Department of National Health and Welfare, Ottawa, Ont.; Ronald Gold, chief, Division of Infectious Diseases, Hospitalfor Sick Children, Toronto, Ont.; Scott A. Halperin, assistant professor ofpediatrics and microbiology, Dalhousie University, Halifax, NS; Gregory Hammond, director, Cadham Provincial Laboratory, Winnipeg, Man.; David W. Scheifele, head, Division of Infectious Diseases, British Columbia's Children's Hospital, Vancouver, BC; John Spika, director, Bureau of Communicable Disease Epidemiology, LCDC, Department of National Health and Welfare, Ottawa, Ont.; David Lorne Tyrrell, chairman, Department ofMedical Microbiology and Infectious Diseases, University ofAlberta, Edmonton, Alta.; and John Waters, director, Communicable Disease Control and Epidemiology, Alberta Community and Occupational Health, Edmonton, Alta. (1991; 17: 165). Publication in CMAJ is with permission of the committee and the bureau.
This NACI statement has been endorsed by the Canadian Paediatric Society. Reprint requests to: Disease Surveillance Division, Bureau of Communicable Disease Epidemiology, Laboratory Centre for Disease Control, Tunney's Pasture, Ottawa, ON KJA OL2 36
CAN MED ASSOCJ 1992; 146(1)
LE jer JANVIER 1992
Universal vaccination against hepatitis B Since hepatitis B vaccine was licensed in Canada in 1982 its use has been restricted to selected high-risk groups.' This strategy has been effective in controlling the disease in health care workers. However, other high-risk groups, including those that account for most cases of hepatitis B, have been difficult to reach.2 Furthermore, 35% of cases of acute hepatitis B occur in people without any recognized risk factor; in these, heterosexual contact seems to play a major role in the transmission of the disease. Over the past 10 years the reported incidence rate of acute hepatitis B in Canada has progressively increased, from 5 to 13 cases per 100 000 population, despite the introduction of vaccine.3 Analysis of passive surveillance data suggests that the epidemiologic profile of hepatitis B in Canada is similar to the one seen in the United States. Data from an intensive surveillance program established in four US sentinel counties have also failed to show any major impact of vaccination on the occurrence of acute hepatitis B.2 There is an emerging consensus among experts in the field that universal vaccination during childhood is the key to the control of hepatitis B in North America.4 The Canadian Paediatric Society, the
American Academy of Pediatrics and the US Immunization Practices Advisory Committee have recently called for universal vaccination of children.5 After reviewing the evidence the National Advisory Committee on Immunization has concluded that to achieve significant control of hepatitis B in Canada universal vaccination should be implemented. This is in addition to the present strategy for high-risk groups. However, such outstanding issues as the cost of the vaccine and optimal scheduling need to be resolved before a specific program can be recommended.
References 1. Statement on hepatitis B vaccine. Can Di.s Wkly Rep 1982; 8: 221-224 2. Alter MJ, Hadler SC, Margolis HS et al: The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies. JAMA 1990; 263: 1218-1222 3. Hepatitis B in Canada: surveillance summary, 1980-1989. Can Dis Wkly Rep 1991; 17: 166-171 4. Hollinger FB and the North American Regional Study Group: Controlling hepatitis B virus transmission in North America. Vaccine 1990; 8 (suppl): S 122-S128 5. Marwick C: Hepatitis B vaccine appears headed for pediatric immunization schedule. JAMA 1991; 265: 1502
Based on material previously reported in Canada Diseases Weekly Report (a publication of the Bureau of Communicable Disease Epidemiology, Laboratory Centre for Disease Control [LCDC], Department ofNational Health and Welfare, Tunney's Pasture, Ottawa, Ont.) by the National Advisory Committee on Immunization (NACI): Drs. Susan E. Tamblvn (chairman), medical officer of health, Perth District Health Unit, Stratford, Ont.; Jacqueline A.K. Carlson, physician manager, Disease Control and Epidemiology Service, Ontario Ministry ofHealth, Toronto, Ont.; John Conly, head, Division of Infectious Diseases, Royal University Hospital, Saskatoon, Sask.; Gilles Delage, Department ofMicrobiology and Immunology, Hopital Sainte-Justine, Montreal, Que.; Pierre Dery, chefdu Service des maladies infectieuses, Departement de pediatrie, Centre hospitalier de l'Universite Laval, Sainte-Foy, Que.; John Furesz, director, Bureau of Biologics, Department of National Health and Welfare, Ottawa, Ont.; Ronald Gold, chief, Division of Infectious Diseases, Hospitalfor Sick Children, Toronto, Ont.; Scott A. Halperin, assistant professor ofpediatrics and microbiology, Dalhousie University, Halifax, NS; Gregory Hammond, director, Cadham Provincial Laboratory, Winnipeg, Man.; David W. Scheifele, head, Division of Infectious Diseases, British Columbia's Children's Hospital, Vancouver, BC; John Spika, director, Bureau of Communicable Disease Epidemiology, LCDC, Department of National Health and Welfare, Ottawa, Ont.; David Lorne Tyrrell, chairman, Department ofMedical Microbiology and Infectious Diseases, University ofAlberta, Edmonton, Alta.; and John Waters, director, Communicable Disease Control and Epidemiology, Alberta Community and Occupational Health, Edmonton, Alta. (1991; 17: 165). Publication in CMAJ is with permission of the committee and the bureau.
This NACI statement has been endorsed by the Canadian Paediatric Society. Reprint requests to: Disease Surveillance Division, Bureau of Communicable Disease Epidemiology, Laboratory Centre for Disease Control, Tunney's Pasture, Ottawa, ON KJA OL2 36
CAN MED ASSOCJ 1992; 146(1)
LE jer JANVIER 1992
