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Notice to Readers Update: Recommendations to Prevent Hepatitis B Virus Transmission -- United States

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).


  1. 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.

  2. CDC. Update: recommendations to prevent hepatitis B virus transmission

    • United States. MMWR 1995;44:574-5.

  3. CDC. National, state, and urban area vaccination coverage levels among children aged 19-35 months -- United States, 1997. MMWR 1998;47:547-54.

  4. CDC. Effectiveness of a seventh grade school entry vaccination requirement -- statewide and Orange County, Florida, 1997-1998. MMWR 1998;47:711-5.

  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.

  6. 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.

  7. CDC. Hepatitis surveillance report no. 56. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, 1995.

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