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In the U.S., an organized effort to eliminate hepatitis B virus (HBV) transmission was begun in 1991. The plan included HBV vaccination of all children and of adults at increased risk for infection. To determine the effect of this program, researchers compared the prevalence of HBV infection among National Health and Nutrition Examination Survey (NHANES) participants in 1988–1994 with that in 1999–2006. Past or present HBV infection was defined as the presence of antibody to hepatitis B core antigen (anti-HBc); chronic infection, as the presence of anti-HBc and HBV surface antigen (HBsAg); and vaccine-induced immunity, as the presence of antibody to HBsAg and absence of anti-HBc.
The overall age-adjusted prevalence of past and present HBV infection did not change significantly between 1988–1994 and 1999–2006 (5.4% and 4.7%). The overall age-adjusted prevalence of chronic infection was also similar between the two periods (0.4% and 0.3%). However, the prevalence of past or present HBV infection did decrease among children aged 6 to 19 years (from 1.9% to 0.6%; P<0.01) and among adults aged 20 to 49 (from 5.9% to 4.6%; P<0.05). In addition, the prevalence of vaccine-induced immunity increased, from 20.5% in 1999–2002 to 25.2% in 2003–2006 (P<0.001).
Wasley A et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis 2010 Jul 15; 202:192.
Comment
The introduction of a vaccine strategy nearly 2 decades ago in this country to eliminate HBV infection has lowered disease prevalence among children and young-to- middle–aged adults. These data indicate that our current elimination strategy must be expanded to ensure its complete success.