Infant and adolescent hepatitis B immunization up to 1999: a global overview.

This article presents a global overview of hepatitis B infant and adolescent immunization programmes. The 108 reported universal infant or adolescent immunization programmes and 87 reported national infant coverage rates fit a pattern, explained by hepatitis B endemicity, prosperity, policy emphasis, and immunization programme strength. Most East and Southeast Asian, Pacific, and Middle Eastern countries have intermediate to highly endemic hepatitis B. Most have achieved 65-100% coverage. South and Central Asia and sub-Saharan Africa have intermediate to high endemicity, with some countries having hepatitis B immunization programmes. Some Southern and Eastern European countries, with intermediate endemicity, have high coverage. Low endemic Northern European countries vaccinate higher risk groups; some have universal infant or adolescent programmes. Caribbean and Latin American countries have varying endemicity, and most started programmes. Low endemic North American countries have universal vaccination programmes. Universal immunization strategies have greatly reduced incidence and prevalence, and are cost-effective for many countries, but many have difficulties affording this vaccine. Globally, most infants are not being immunized against hepatitis B virus infection. Increasing coverage, and decreasing the numbers of people diseased and dying from this virus, may require delivering heat-stable vaccine beyond cold chains, creative financing to reduce prices, and multivalent vaccines.