ATLANTA — A risk-targeted strategy will remain the recommended approach to adult hepatitis B vaccination, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.
The committee has been considering revising this recommendation, which has been in place since 1982 because the burden of disease remains large. Last year there were 60,000 cases of hepatitis B in the United States, said Eric Mast, M.D., of the CDC's division of viral hepatitis.
Tracy Lieu, M.D., who chairs the ACIP working group on hepatitis, explained that consideration had been given to adding a recommendation for universal vaccination of 19- to 25-year-olds, as a temporary catch-up program until such time as the vaccinated cohort of children reaches adulthood.
Doing so could potentially reach more young adults, including those with no risk factors, and it could simplify vaccination decision-making, said Dr. Lieu of Harvard Pilgrim Health Care and Harvard Medical School, Boston. It would also remove the stigma of having to disclose risk factors. “And I think we're all in agreement that the infrastructure for adult vaccination could use better development.”
“But for me and most of the working group members, the rationale against adding universal vaccination of 19- to 25-year-olds is more compelling,” Dr. Lieu added.
The catch-up strategy would likely prevent few additional cases beyond the risk-targeted approach. “More than 90% of people who get hepatitis B could be identified by the risk-targeted strategy, and there's little evidence that adding universal vaccination of young adults would reach the highest-risk people we're hoping to invest our energy in,” she said.
Furthermore, the additional cost would be substantial, and would divert resources from risk-targeted efforts. “It just wouldn't get us that much more,” Dr. Lieu said. Most of her ACIP colleagues agreed, voting to maintain the risk-targeted strategy.
Persons considered at high risk for hepatitis B infection include men who have sex with men, heterosexuals who have had more than one sex partner during the past 6 months, and those who have sexual contact with an infected person.