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Epidemiologic Reviews Advance Access published online on June 5, 2006
Epidemiologic Reviews, doi:10.1093/epirev/mxj009
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Epidemiologic Reviews Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Accepted March 28, 2006

Article

Hepatitis B Virus Infection: Epidemiology and Vaccination

Colin W. Shepard 1, Edgar P. Simard 1, Lyn Finelli 1, Anthony E. Fiore 1 *, and Beth P. Bell 1

1 From the Epidemiology Branch, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA

* To whom correspondence should be addressed.
Anthony E. Fiore, E-mail: abf4{at}cdc.gov


  Abstract

Worldwide, two billion people have been infected with hepatitis B virus (HBV), 360 million have chronic infection, and 600,000 die each year from HBV-related liver disease or hepatocellular carcinoma. This comprehensive review of hepatitis B epidemiology and vaccines focuses on definitive and influential studies and highlights current trends, policies, and directions. HBV can be transmitted vertically, through sexual or household contact, or by unsafe injections, but chronic infections acquired during infancy or childhood account for a disproportionately large share of worldwide morbidity and mortality. Vaccination against HBV infection can be started at birth and provides long-term protection against infection in more than 90% of healthy people. In the 1990s, many industrialized countries and a few less-developed countries implemented universal hepatitis B immunization and experienced measurable reductions in HBV-related disease. For example, in Taiwan, the prevalence of chronic infection in children declined by more than 90%. Many resource-poor nations have recently initiated universal hepatitis B immunization programs with assistance from the Global Alliance for Vaccines and Immunization. Further progress towards the elimination of HBV transmission will require sustainable vaccination programs with improved vaccination coverage, practical methods of measuring the impact of vaccination programs, and targeted vaccination efforts for communities at high risk of infection.

Keywords: hepatitis B; hepatitis B vaccines; hepatitis B virus; immunization programs.
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