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Introduction of universal infant hepatitis B immunisation in the UK– paving the way to elimination

Introduction of universal infant hepatitis B immunisation in the UK– paving the way to elimination HUMAN VACCINES & IMMUNOTHERAPEUTICS 2019, VOL. 15, NO. 2, 440–443 https://doi.org/10.1080/21645515.2018.1528837 COMMENTARY Introduction of universal infant hepatitis B immunisation in the UK– paving the way to elimination Sema Mandal Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK ABSTRACT ARTICLE HISTORY Received 10 September 2018 In May 2016, the World Health Assembly ratified the first ever Global Health Sector Strategy (GHSS) on Accepted 22 September 2018 Viral Hepatitis to eliminate viral hepatitis as a public health threat by 2030. In pursuit of this elimination goal and recognising that hepatitis control through immunisation is an essential foundation of a KEYWORDS hepatitis B prevention programme, the World Health Organization set out vaccine coverage targets Hepatitis B; universal for both universal and selective childhood immunisation programmes, focusing on preventing mother immunisation; selective to child transmission. immunisation; elimination In August 2017 the UK introduced a hexavalent (DTaP/IPV/Hib/HepB) combination vaccine into the routine childhood immunisation programme, replacing the pentavalent vaccine given to all infants at 8, 12 and 16 weeks. With the addition of the 6th component to protect against hepatitis B the UK finally introduced universal hepatitis B immunisation. Prior to that, the UK had a selective immunisation policy targeting high risk groups for hepatitis B – including infants born to hepatitis B infected mothers. We tell the story of hepatitis B vaccination in the UK, and how we have evolved from selective to a universal infant immunisation programme, the factors considered in hepatitis B vaccine policy decision-making, and the progress towards elimination of viral hepatitis as a public health threat. Introduction hepatitis B vaccine policy decision-making, and the progress towards elimination of viral hepatitis as a public health threat. In May 2016, 194 member states of the World Health Assembly – including the UK – signed up to the first ever Global Health Sector Strategy (GHSS) on Viral Epidemiology of hepatitis B Hepatitis to eliminate viral hepatitis as a public health Worldwide, an estimated 257 million people are living with threat by 2030. This strategy set global targets for viral hepatitis B infection, resulting in almost 900,000 deaths. hepatitis, with a goal of a 90% reduction in incident hepa- Despite this clear burden, public and professional awareness titis B (and C) chronic cases and 65% reduction in mortal- of hepatitis B remains low compared to HIV and other infec- ity by 2030. In pursuit of this ultimate elimination goal and tions. Dubbed the ‘Silent Killer’, many of those who are recognising that hepatitis control through immunisation is chronically infected do not know they have the virus until an essential foundation of a hepatitis B prevention pro- cirrhosis or hepatocellular carcinoma has already occurred. gramme, the World Health Organization set out vaccine The hepatitis B virus (HBV), a double-stranded DNA coverage targets for both universal childhood immunisation hepadnavirus, is 50–100 times more infectious than HIV, and selective immunisation to prevent mother to child and transmitted through percutaneous, mucocutaneous and transmission. vertical route. Acute infection is often not clinically recogni- In August 2017 the UK took a big step forward in the fight sable; less than 10% of infants and 30–50% of adults show against viral hepatitis -specifically hepatitis B – with the non-specific symptoms. In a very small number of acute incorporation of the hexavalent (DTaP/IPV/Hib/HepB) com- cases (0.1–0.5%), the infection may lead to fulminant hepatic bination vaccine into the routine childhood immunisation failure which can be fatal. Whilst most adults are able to clear programme. This vaccine is now offered to all infants at 8, the virus and make a full recovery, a small proportion (5– 12 and 16 weeks, replacing the pentavalent vaccine which 10%) will progress to chronic, persistent infection. Younger protected against diphtheria, tetanus, pertussis, polio and individuals are less likely to clear the infection, with up to 50% haemophilus influenzae type B. With the addition of the 6th of children and 90% of infants progressing to chronic disease. component, infants are now protected against hepatitis B. In most developed countries, the seroprevalence of HBV In this article, we tell the story of hepatitis B vaccination in infection is less than 2%. In these areas, most new cases occur the UK, and how we have evolved from selective to a universal among young adults through sexual intercourse or sharing of infant immunisation programme, the factors considered in needles among people who inject drugs. In countries, such as CONTACT Sema Mandal Sema.Mandal@phe.gov.uk Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK © 2018 Crown Copyright HUMAN VACCINES & IMMUNOTHERAPEUTICS 441 those in Sub-Saharan Africa, South Asia and the Pacific hepatitis B into their primary infant routine immunisation Islands where the prevalence is high (>8%), vertical transmis- programmes. At the time, because of the low prevalence and sion from mother to child is the predominant route of trans- incidence in the UK, it was not cost-effective to implement a mission. In the UK, an estimated 0.4% of the population have universal programme using the available monovalent hepatitis chronic hepatitis B with the bulk of disease burden in B vaccines. migrants who have acquired the infection overseas in endemic countries prior to arrival in the UK. Overall, the UK is UK considerations for introduction of universal classified as a low incidence and prevalence country. hepatitis B vaccination In England, the Department of Health and Social Care Selective versus universal immunisation against (DHSC) makes vaccine policy on the basis of recommenda- hepatitis B tions from an expert independent scientific committee, the Sincesafeand effectivehepatitis Bvaccinesbecameavail- Joint Committee on Vaccination and Immunisation (JCVI). able in the late 1980s the UK has had a selective immunisa- The JCVI reviews data on safety, immunogenicity (including tion policy recommending vaccination of those at increased that of other antigens in combination vaccines and concomi- risk of hepatitis B exposure e.g. healthcare workers, renal tantly administered vaccines), efficacy, cost effectiveness and dialysis patients, people who inject drugs, prisoners and vaccine uptake for immunisation programmes. The NHS people travelling long-term or living in endemic countries. Constitution mandates that JCVI can only recommend a Additionally, vaccination is recommended for those at new vaccine programme if it meets the cost-effectiveness increased risk of complications from hepatitis B. e.g. people criteria: a cost per quality life adjusted year (QALY) of equal with other chronic liver conditions, people living with HIV, or less than £20,000. andalsofor those who have had a significantexposuretoa In 2009, the Secretary of State for Health requested a known or unknown hepatitis B infected individual (post recommendation from the JCVI on universal hepatitis B vac- exposure vaccination). cination. The JCVI were unable to recommend universal Universal antenatal screening has been in place since 2000, vaccination as the evidence indicated that a stand-alone and identifies around 3,000 hepatitis B positive pregnant (monovalent) hepatitis B vaccine was highly unlikely to be women each year so that selective vaccination of the at-risk cost-effective. The model was based on the estimated inci- infant can be given. This selective hepatitis B immunisation dence of acute infection, as most chronic hepatitis B in the programme provides post exposure vaccination starting from UK is imported in adults and not preventable by a UK infant birth for neonates, the group at highest individual risk of vaccination programme. Economic models did suggest, how- infection, as they have already been exposed to infected ever, that the use of a combination infant vaccine containing blood during birth. Without intervention, up to 90% of hepa- hepatitis B could make a universal infant programme cost titis B infected women will transmit infection to their infant effective. However, there were concerns that the available perinatally, leading to chronic infection. With post-exposure infant hepatitis B-containing combination vaccines (those vaccination of the infant starting immediately at birth and including 2- or 3-component acellular-pertussis antigens) continuing at 4 weeks, 8 weeks and with a booster at one year, could produce inferior Hib responses. The UK had just recov- however, this risk is dramatically reduced to below 10%. ered from a resurgence of Hib disease in 2000 to 2002 when a Infants born to mothers at particularly high risk of HBV 3-component acellular pertussis pentavalent infant vaccine transmission (e.g. viral load >10 IU/ml at any time in the was temporarily used during a period of vaccine shortage. pregnancy, hepatitis B e antigen positive, or hepatitis B e After a Hib booster at around one year of age was added to antibody negative, acute hepatitis B in pregnancy) are also the schedule in 2006, the UK was able to use a pentavalent given hepatitis B immunoglobulin at birth which provides vaccine containing 3-component acellular-pertussis and had marginal additional protection beyond vaccine. In addition several years of sustained control of Hib. Therefore, in 2014, pregnant women with a high viral load are also recom- the JCVI re-evaluated their earlier advice and recommended mended to receive antiviral treatment in the third trimester. that a universal hepatitis B infant programme would not be a Allchildrenborntoinfectedmothersarerecommended to risk to the control of Hib and was highly likely to be cost- have a blood test for the presence of hepatitis B surface effective. A suitable combination vaccine (Infanrix hexa®) antigen (HBsAg) at one year of age (for convenience, at the was procured to commence routine infant immunisation same time as routine vaccinations) to confirm or exclude from late 2017. chronic infection and allow early specialist referral, if While Infanrix hexa® is new to the UK, it has been licensed infected. Without testing, infected children may be missed in Europe since 2000 with worldwide successful implementa- as they are unlikely to show any symptoms or signs to tion into routine programmes. It is licensed in and at least 97 prompt testing. With over 95% uptake of vaccine at birth other countries including Canada, Australia and New Zealand andaround80% uptake forsubsequentdoses,thispro- and an estimated 150 million doses have been given to infants gramme hasbeensuccessful inpreventing maternal to worldwide to-date, with no safety concerns. Following three child transmission and is knowntobehighlycost-effective. doses of the vaccine at 8, 12 and 16 weeks, clinical trials have In 1992, the World Health Assembly called for every shown nearly all children develop protective antibody titres country to adopt a universal hepatitis B immunisation pro- against diphtheria (100%), tetanus (100%), pertussis (100%), gramme by 1997. By 2008, 177 countries had incorporated hepatitis B (99.5%), polio (98–100%) and Hib (96%). 442 S. MANDAL Figure 1. UK hepatitis B vaccine schedules for the routine childhood and selective neonatal immunisation programmes. The recognition of viral hepatitis as a global major health Integrating universal and selective hepatitis B burden and the united call for action to tackle it is a huge step immunisation schedules forward in reducing the worldwide burden of this disease. By As the hexavalent vaccine is not given until eight weeks, JCVI incorporating hepatitis B vaccine into the childhood immuni- also considered the best way to protect children born to sation programme, the UK has shown renewed commitment hepatitis B positive mothers. They recommended that the to this goal. babies still need to have the birth and 4 weeks doses (with monovalent vaccine) as these post exposure doses are critical to prevent maternal to child transmission at birth. These Disclosure of potential conflicts of interest infants should then continue with hexavalent vaccine as part No potential conflicts of interest were disclosed. of the routine schedule at 8, 12, and 16 weeks and have a final monovalent hepatitis B vaccine dose at 1 year old, alongside the test to exclude chronic infection (see Figure 1). While this Funding amounts to six doses of hepatitis B vaccine by the age of one, none it was considered the safest option to ensure that protection was not compromised – for example if infants receive their routine doses late. The pre-school booster dose of hepatitis References B vaccine was removed. 1. World Health Organization. Hepatitis B fact sheet; 2017 accessed 2018 Mar 16. http://www.who.int/mediacentre/factsheets/fs204/ en/. Progress towards the elimination goal 2. Health Protection Surveillance Centre. Hepatitis B virus: epide- miology and transmission risks; 2016 May. http://www.hpsc.ie/a- With the well-established selective neonatal immunisation z/EMIToolkit/appendices/app21-26.pdf. programme, the UK has already exceeded the WHO GHSS 3. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B 2030 90% birth dose target (to prevent maternal to child virus infection: epidemiology and vaccination. Epidemiol Rev. transmission) in at-risk infants. With the introduction of 2006;28:112–125. doi:10.1093/epirev/mxj009. universal childhood immunisation the 90% coverage third 4. Gentile I, Borgia G. Vertical transmission of hepatitis B virus: challenges and solutions. Int J Womens Health. 2014;6:605–611. dose target should be easily attainable in UK as the penta- doi:10.2147/IJWH.S51138. valent vaccine coverage has exceeded 90% for the last ten 5. Yi P, Chen R, Huang Y, Zhou RR, Fan XG. Management of years. Based on market research into parents’ attitudes, we mother-to-child transmission of hepatitis B virus: propositions expect coverage of the new hexavalent vaccine to be equiva- and challenges. J Clin Virol. 2016;77:32–39. doi:10.1016/j. lent to that achieved for pentavalent vaccine. jcv.2016.02.003. HUMAN VACCINES & IMMUNOTHERAPEUTICS 443 6. National Institute for Health and Care Excellence. The guidelines groups/joint-comm i ttee-on-vaccination-and- manual, Chapter 7 Assessing cost effectiveness; 2012. https:// immunisation#minutes. www.nice.org.uk/process/pmg6/chapter/assessing-cost- 9. GlaxoSmithKline UK. Summary of product characteristics— effectiveness. infanrix hexa, powder and suspension for suspension for injec- 7. Siddiqui MR, Gay N, Edmunds WJ, Ramsay M. Economic evalua- tion. Electronic Medicines Compendium 2017 accessed 2018 Apr tion of infant and adolescent hepatitis B vaccination in the UK. 10. https://www.medicines.org.uk/emc/medicine/33313. Vaccine. 2011;29(3):466–475. doi:10.1016/j.vaccine.2010.10.075. 10. The Joint Committee on Vaccination and Immunisation. Minute of 8. The Joint Committee on Vaccination and Immunisation. Minute the meeting; 2016 Oct 5 https://www.gov.uk/government/groups/ of the meeting; 2014 Oct 1. https://www.gov.uk/government/ joint-committee-on-vaccination-and-immunisation#minutes. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Human Vaccines & Immunotherapeutics Taylor & Francis

Introduction of universal infant hepatitis B immunisation in the UK– paving the way to elimination

Mandal, Sema
Human Vaccines & Immunotherapeutics , Volume 15 (2): 4 – Feb 1, 2019
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Taylor & Francis
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© 2018 Crown Copyright
ISSN
2164-554X
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2164-5515
DOI
10.1080/21645515.2018.1528837
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Abstract

HUMAN VACCINES & IMMUNOTHERAPEUTICS 2019, VOL. 15, NO. 2, 440–443 https://doi.org/10.1080/21645515.2018.1528837 COMMENTARY Introduction of universal infant hepatitis B immunisation in the UK– paving the way to elimination Sema Mandal Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK ABSTRACT ARTICLE HISTORY Received 10 September 2018 In May 2016, the World Health Assembly ratified the first ever Global Health Sector Strategy (GHSS) on Accepted 22 September 2018 Viral Hepatitis to eliminate viral hepatitis as a public health threat by 2030. In pursuit of this elimination goal and recognising that hepatitis control through immunisation is an essential foundation of a KEYWORDS hepatitis B prevention programme, the World Health Organization set out vaccine coverage targets Hepatitis B; universal for both universal and selective childhood immunisation programmes, focusing on preventing mother immunisation; selective to child transmission. immunisation; elimination In August 2017 the UK introduced a hexavalent (DTaP/IPV/Hib/HepB) combination vaccine into the routine childhood immunisation programme, replacing the pentavalent vaccine given to all infants at 8, 12 and 16 weeks. With the addition of the 6th component to protect against hepatitis B the UK finally introduced universal hepatitis B immunisation. Prior to that, the UK had a selective immunisation policy targeting high risk groups for hepatitis B – including infants born to hepatitis B infected mothers. We tell the story of hepatitis B vaccination in the UK, and how we have evolved from selective to a universal infant immunisation programme, the factors considered in hepatitis B vaccine policy decision-making, and the progress towards elimination of viral hepatitis as a public health threat. Introduction hepatitis B vaccine policy decision-making, and the progress towards elimination of viral hepatitis as a public health threat. In May 2016, 194 member states of the World Health Assembly – including the UK – signed up to the first ever Global Health Sector Strategy (GHSS) on Viral Epidemiology of hepatitis B Hepatitis to eliminate viral hepatitis as a public health Worldwide, an estimated 257 million people are living with threat by 2030. This strategy set global targets for viral hepatitis B infection, resulting in almost 900,000 deaths. hepatitis, with a goal of a 90% reduction in incident hepa- Despite this clear burden, public and professional awareness titis B (and C) chronic cases and 65% reduction in mortal- of hepatitis B remains low compared to HIV and other infec- ity by 2030. In pursuit of this ultimate elimination goal and tions. Dubbed the ‘Silent Killer’, many of those who are recognising that hepatitis control through immunisation is chronically infected do not know they have the virus until an essential foundation of a hepatitis B prevention pro- cirrhosis or hepatocellular carcinoma has already occurred. gramme, the World Health Organization set out vaccine The hepatitis B virus (HBV), a double-stranded DNA coverage targets for both universal childhood immunisation hepadnavirus, is 50–100 times more infectious than HIV, and selective immunisation to prevent mother to child and transmitted through percutaneous, mucocutaneous and transmission. vertical route. Acute infection is often not clinically recogni- In August 2017 the UK took a big step forward in the fight sable; less than 10% of infants and 30–50% of adults show against viral hepatitis -specifically hepatitis B – with the non-specific symptoms. In a very small number of acute incorporation of the hexavalent (DTaP/IPV/Hib/HepB) com- cases (0.1–0.5%), the infection may lead to fulminant hepatic bination vaccine into the routine childhood immunisation failure which can be fatal. Whilst most adults are able to clear programme. This vaccine is now offered to all infants at 8, the virus and make a full recovery, a small proportion (5– 12 and 16 weeks, replacing the pentavalent vaccine which 10%) will progress to chronic, persistent infection. Younger protected against diphtheria, tetanus, pertussis, polio and individuals are less likely to clear the infection, with up to 50% haemophilus influenzae type B. With the addition of the 6th of children and 90% of infants progressing to chronic disease. component, infants are now protected against hepatitis B. In most developed countries, the seroprevalence of HBV In this article, we tell the story of hepatitis B vaccination in infection is less than 2%. In these areas, most new cases occur the UK, and how we have evolved from selective to a universal among young adults through sexual intercourse or sharing of infant immunisation programme, the factors considered in needles among people who inject drugs. In countries, such as CONTACT Sema Mandal Sema.Mandal@phe.gov.uk Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK © 2018 Crown Copyright HUMAN VACCINES & IMMUNOTHERAPEUTICS 441 those in Sub-Saharan Africa, South Asia and the Pacific hepatitis B into their primary infant routine immunisation Islands where the prevalence is high (>8%), vertical transmis- programmes. At the time, because of the low prevalence and sion from mother to child is the predominant route of trans- incidence in the UK, it was not cost-effective to implement a mission. In the UK, an estimated 0.4% of the population have universal programme using the available monovalent hepatitis chronic hepatitis B with the bulk of disease burden in B vaccines. migrants who have acquired the infection overseas in endemic countries prior to arrival in the UK. Overall, the UK is UK considerations for introduction of universal classified as a low incidence and prevalence country. hepatitis B vaccination In England, the Department of Health and Social Care Selective versus universal immunisation against (DHSC) makes vaccine policy on the basis of recommenda- hepatitis B tions from an expert independent scientific committee, the Sincesafeand effectivehepatitis Bvaccinesbecameavail- Joint Committee on Vaccination and Immunisation (JCVI). able in the late 1980s the UK has had a selective immunisa- The JCVI reviews data on safety, immunogenicity (including tion policy recommending vaccination of those at increased that of other antigens in combination vaccines and concomi- risk of hepatitis B exposure e.g. healthcare workers, renal tantly administered vaccines), efficacy, cost effectiveness and dialysis patients, people who inject drugs, prisoners and vaccine uptake for immunisation programmes. The NHS people travelling long-term or living in endemic countries. Constitution mandates that JCVI can only recommend a Additionally, vaccination is recommended for those at new vaccine programme if it meets the cost-effectiveness increased risk of complications from hepatitis B. e.g. people criteria: a cost per quality life adjusted year (QALY) of equal with other chronic liver conditions, people living with HIV, or less than £20,000. andalsofor those who have had a significantexposuretoa In 2009, the Secretary of State for Health requested a known or unknown hepatitis B infected individual (post recommendation from the JCVI on universal hepatitis B vac- exposure vaccination). cination. The JCVI were unable to recommend universal Universal antenatal screening has been in place since 2000, vaccination as the evidence indicated that a stand-alone and identifies around 3,000 hepatitis B positive pregnant (monovalent) hepatitis B vaccine was highly unlikely to be women each year so that selective vaccination of the at-risk cost-effective. The model was based on the estimated inci- infant can be given. This selective hepatitis B immunisation dence of acute infection, as most chronic hepatitis B in the programme provides post exposure vaccination starting from UK is imported in adults and not preventable by a UK infant birth for neonates, the group at highest individual risk of vaccination programme. Economic models did suggest, how- infection, as they have already been exposed to infected ever, that the use of a combination infant vaccine containing blood during birth. Without intervention, up to 90% of hepa- hepatitis B could make a universal infant programme cost titis B infected women will transmit infection to their infant effective. However, there were concerns that the available perinatally, leading to chronic infection. With post-exposure infant hepatitis B-containing combination vaccines (those vaccination of the infant starting immediately at birth and including 2- or 3-component acellular-pertussis antigens) continuing at 4 weeks, 8 weeks and with a booster at one year, could produce inferior Hib responses. The UK had just recov- however, this risk is dramatically reduced to below 10%. ered from a resurgence of Hib disease in 2000 to 2002 when a Infants born to mothers at particularly high risk of HBV 3-component acellular pertussis pentavalent infant vaccine transmission (e.g. viral load >10 IU/ml at any time in the was temporarily used during a period of vaccine shortage. pregnancy, hepatitis B e antigen positive, or hepatitis B e After a Hib booster at around one year of age was added to antibody negative, acute hepatitis B in pregnancy) are also the schedule in 2006, the UK was able to use a pentavalent given hepatitis B immunoglobulin at birth which provides vaccine containing 3-component acellular-pertussis and had marginal additional protection beyond vaccine. In addition several years of sustained control of Hib. Therefore, in 2014, pregnant women with a high viral load are also recom- the JCVI re-evaluated their earlier advice and recommended mended to receive antiviral treatment in the third trimester. that a universal hepatitis B infant programme would not be a Allchildrenborntoinfectedmothersarerecommended to risk to the control of Hib and was highly likely to be cost- have a blood test for the presence of hepatitis B surface effective. A suitable combination vaccine (Infanrix hexa®) antigen (HBsAg) at one year of age (for convenience, at the was procured to commence routine infant immunisation same time as routine vaccinations) to confirm or exclude from late 2017. chronic infection and allow early specialist referral, if While Infanrix hexa® is new to the UK, it has been licensed infected. Without testing, infected children may be missed in Europe since 2000 with worldwide successful implementa- as they are unlikely to show any symptoms or signs to tion into routine programmes. It is licensed in and at least 97 prompt testing. With over 95% uptake of vaccine at birth other countries including Canada, Australia and New Zealand andaround80% uptake forsubsequentdoses,thispro- and an estimated 150 million doses have been given to infants gramme hasbeensuccessful inpreventing maternal to worldwide to-date, with no safety concerns. Following three child transmission and is knowntobehighlycost-effective. doses of the vaccine at 8, 12 and 16 weeks, clinical trials have In 1992, the World Health Assembly called for every shown nearly all children develop protective antibody titres country to adopt a universal hepatitis B immunisation pro- against diphtheria (100%), tetanus (100%), pertussis (100%), gramme by 1997. By 2008, 177 countries had incorporated hepatitis B (99.5%), polio (98–100%) and Hib (96%). 442 S. MANDAL Figure 1. UK hepatitis B vaccine schedules for the routine childhood and selective neonatal immunisation programmes. The recognition of viral hepatitis as a global major health Integrating universal and selective hepatitis B burden and the united call for action to tackle it is a huge step immunisation schedules forward in reducing the worldwide burden of this disease. By As the hexavalent vaccine is not given until eight weeks, JCVI incorporating hepatitis B vaccine into the childhood immuni- also considered the best way to protect children born to sation programme, the UK has shown renewed commitment hepatitis B positive mothers. They recommended that the to this goal. babies still need to have the birth and 4 weeks doses (with monovalent vaccine) as these post exposure doses are critical to prevent maternal to child transmission at birth. These Disclosure of potential conflicts of interest infants should then continue with hexavalent vaccine as part No potential conflicts of interest were disclosed. of the routine schedule at 8, 12, and 16 weeks and have a final monovalent hepatitis B vaccine dose at 1 year old, alongside the test to exclude chronic infection (see Figure 1). While this Funding amounts to six doses of hepatitis B vaccine by the age of one, none it was considered the safest option to ensure that protection was not compromised – for example if infants receive their routine doses late. The pre-school booster dose of hepatitis References B vaccine was removed. 1. World Health Organization. Hepatitis B fact sheet; 2017 accessed 2018 Mar 16. http://www.who.int/mediacentre/factsheets/fs204/ en/. Progress towards the elimination goal 2. Health Protection Surveillance Centre. Hepatitis B virus: epide- miology and transmission risks; 2016 May. http://www.hpsc.ie/a- With the well-established selective neonatal immunisation z/EMIToolkit/appendices/app21-26.pdf. programme, the UK has already exceeded the WHO GHSS 3. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B 2030 90% birth dose target (to prevent maternal to child virus infection: epidemiology and vaccination. Epidemiol Rev. transmission) in at-risk infants. With the introduction of 2006;28:112–125. doi:10.1093/epirev/mxj009. universal childhood immunisation the 90% coverage third 4. Gentile I, Borgia G. Vertical transmission of hepatitis B virus: challenges and solutions. Int J Womens Health. 2014;6:605–611. dose target should be easily attainable in UK as the penta- doi:10.2147/IJWH.S51138. valent vaccine coverage has exceeded 90% for the last ten 5. Yi P, Chen R, Huang Y, Zhou RR, Fan XG. Management of years. Based on market research into parents’ attitudes, we mother-to-child transmission of hepatitis B virus: propositions expect coverage of the new hexavalent vaccine to be equiva- and challenges. J Clin Virol. 2016;77:32–39. doi:10.1016/j. lent to that achieved for pentavalent vaccine. jcv.2016.02.003. HUMAN VACCINES & IMMUNOTHERAPEUTICS 443 6. National Institute for Health and Care Excellence. The guidelines groups/joint-comm i ttee-on-vaccination-and- manual, Chapter 7 Assessing cost effectiveness; 2012. https:// immunisation#minutes. www.nice.org.uk/process/pmg6/chapter/assessing-cost- 9. GlaxoSmithKline UK. Summary of product characteristics— effectiveness. infanrix hexa, powder and suspension for suspension for injec- 7. Siddiqui MR, Gay N, Edmunds WJ, Ramsay M. Economic evalua- tion. Electronic Medicines Compendium 2017 accessed 2018 Apr tion of infant and adolescent hepatitis B vaccination in the UK. 10. https://www.medicines.org.uk/emc/medicine/33313. Vaccine. 2011;29(3):466–475. doi:10.1016/j.vaccine.2010.10.075. 10. The Joint Committee on Vaccination and Immunisation. Minute of 8. The Joint Committee on Vaccination and Immunisation. Minute the meeting; 2016 Oct 5 https://www.gov.uk/government/groups/ of the meeting; 2014 Oct 1. https://www.gov.uk/government/ joint-committee-on-vaccination-and-immunisation#minutes.

Journal

Human Vaccines & Immunotherapeutics – Taylor & Francis

Published: Feb 1, 2019

Keywords: Hepatitis B; universal immunisation; selective immunisation; elimination

There are no references for this article.