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

In October 1994, the Advisory Committee on Immunization Practices (ACIP) approved recommendations expanding the vaccination strategy to eliminate hepatitis B virus (HBV) transmission in the United States. These recommendations include:

  1. Vaccination of all unvaccinated children aged less than 11

years who are Pacific Islanders or who reside in households of first-generation immigrants from countries where HBV is of high or intermediate endemicity.

2. Vaccination of all 11-12-year-old children who have not previously received hepatitis B vaccine. Reported by: Epidemiology and Surveillance Div, National Immunization Program; Hepatitis Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: In November 1991, the ACIP recommended that hepatitis B vaccine be integrated into infant vaccination schedules (1). However, high rates of HBV infection continue to occur among children aged 0-10 years who are Alaskan Natives, Pacific Islanders, and infants of first-generation immigrant mothers from areas where HBV infection is of high or intermediate endemicity. Among children in these populations, the prevalence of chronic HBV infection ranges from 2%-5%, and infection rates average 2% per year (2,3). These infections occur in children born to women who are hepatitis B surface antigen-negative and account for a large proportion of the chronic HBV infections that occur each year in the United States. Of the estimated 1 million Asian and Pacific Islander children aged 2-10 years in the United States, less than 10% have received hepatitis B vaccine. Special efforts should be made to ensure hepatitis B vaccination of these populations because of their high risk for chronic HBV infection and death from HBV-related chronic liver disease.

Routine infant hepatitis B vaccination is the most effective means to prevent HBV transmission in the United States. The effect of routine infant vaccination on acute disease incidence may not be apparent for 20-30 years because currently most infections occur among young adults. Vaccination of previously unvaccinated children at age 11-12 years should result in a more rapid decline in the incidence of HBV infection. However, adolescent hepatitis B vaccination should not supplant vaccination of infants, because routine infant hepatitis B vaccination would eventually eliminate the need for adolescent and adult vaccination.

Vaccination recommendations are most effective when they become integrated into routine health care. Although preventive health services and vaccination visits for adolescents are not well established in the United States, hepatitis B vaccination of this age group has been successful in settings including schools and clinical practices (4,5). The ACIP has recommended that hepatitis B vaccination of adolescents be done as part of a routine adolescent vaccination visit at age 11-12 years. This visit should be used to ensure that all adolescents have received three doses of hepatitis B vaccine, two doses of measles-mumps-rubella vaccine, a booster dose of tetanus and diphtheria toxoids, and to assess whether adolescents are immune to varicella. The establishment of an adolescent vaccination visit provides the opportunity to deliver preventive health-care services to this underserved population.


  1. Mahoney FJ, Lawrence M, Scott K, Le Q, Lambert S, Farley T. Continuing risk for hepatitis B virus transmission among Southeast Asian infants in Louisiana. Pediatrics (in press).

  2. Hurie MB, Mast EE, Davis JP. Horizontal transmission of hepatitis B virus infection to United States-born children of Hmong refugees. Pediatrics 1992;89:269-73.

  3. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination -- recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no. RR-13).

  4. CDC. Hepatitis B vaccination of adolescents -- California, Louisiana, and Oregon, 1992-1994. MMWR 1994;43:605-9.

  5. Kollar LM, Rosenthal SL, Biro FM. Hepatitis B vaccine series compliance in adolescents. Pediatr Infect Dis J 1994;13:1006-8.

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