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Universal hepatitis B vaccination hailed a success in Italy
Newsdesk
Since Italy introduced mandatory universal hepatitis B virus (HBV) vaccination in 1992, the incidence of infection with the virus has fallen from 5·1 per 100 000 population in 1991 to 1·3 cases per 100 000 people in 2005. “The Italian success provides additional evidence that universal HBV vaccination is efficacious and worthwhile”, said Mei-Hwei Chang (National Taiwan University Hospital, Taiwan). “These findings will encourage those few European countries who are still to convince their government that universal HBV vaccination in childhood is both feasible and desirable.” Many European countries now offer HBV universal vaccination. Notable exceptions include Denmark, Finland, Ireland, Sweden, and the UK. These countries have low endemicity but, as Jane Zuckerman (University College, London, UK) has previously noted, “Increased travel and integration of immigrant communities are increasing the number of at-risk individuals”.
The Centers for Disease Control and Prevention’s vaccination schedule in the USA incorporates universal HBV vaccination, now recommending vaccination of all children in infancy. But HBV prevalence is still high in adults of Asian origin. “Immigrants from endemic areas such as Asia may have been infected by HBV during infancy or in early childhood before they arrived in the USA”, Chang told TLID. Taiwan, like many countries in Asia, runs a successful programme: before its launch in 1984, a fifth of the population were carrying HBV. Today, only 1% of those aged below 20 years have chronic HBV and the carrier rate in children is expected to fall below 0·1%. Despite the successes, there are still 360 million chronic carriers worldwide and untreated HBV infection is the leading cause of liver-related death. “In developing countries, the proportion of HBV vaccination coverage is increasing year by year, but coverage is low because of financial constraints”, commented
Chang. Douglas Dieterich (Mount Sinai School of Medicine, New York, USA) added that HIV and HBV compound each other’s morbidities—in Asia and Africa they account for substantial liverrelated death. HBV/HIV co-infection is also a problem in the developed world, despite better availability of drug treatment. Tenofovir, the most commonly prescribed HIV medication, is just as active against hepatitis B and was approved by 27 EU member states specifically for the treatment of chronic hepatitis B at the end of April. World Hepatitis Day was marked for the first time on May 19, an initiative of the World Hepatitis Alliance (WHA), a coalition of patient groups. Their aim is to raise awareness of hepatitis B and C and to galvanise changes in global policy. The WHA is calling for WHO to endorse this new international day, as a step towards ensuring increased recognition around hepatitis.
Kathryn Senior
Adam Gault/Science Photo Library
Universal hepatitis B vaccination hailed a success in Italy
For more on the study on acute hepatitis B in Italy see Clin Infect Dis 2008; 46: 868–75; DOI:10.1086/528687 For a WHO graph showing HBV vaccine coverage see http:// www.who.int/entity/ immunization_monitoring/ diseases/HepB_coverage.jpg For more on universal HBV vaccination see Review Lancet Infect Dis 2007; 7: 410–19 For more on HIV and hepatitis B co-infection in Asia and Africa see Review Lancet Infect Dis 2007; 7: 402–09 For more on the World Hepatitis Day see http://hepccentre.org.uk
Greater interest and investment in female condoms needed As the US Congress moved in April to reauthorise the President’s Emergency Plan for AIDS Relief (PEPFAR), a report from the Center for Health and Gender Equity (CHANGE) has found that female condoms are underused and underfunded. The report, Saving lives: female condoms and the role of US foreign aid, advocates that US agencies and policy makers ensure PEPFAR-funded programmes include “access to a full range of approved prevention methods—especially those that women can initiate”, said Serra Sippel, executive director of CHANGE (Takoma Park, MD, USA). Research suggests that female condoms are effective in preventing sexually transmitted infections and as a contraceptive. “In the few countries where governments have committed to long-term http://infection.thelancet.com Vol 8 June 2008
provision of female condoms, uptake is sustained”, noted Sippel, which suggests that use depends on perceptions and promotion. However, she observes “a mismatch between attitudes in situations where female condoms are distributed compared with attitudes in the USA”. Yasmin Madan (Population Services International) explains that although the US government is the largest global provider of female condoms, there is “some degree of scepticism” about their role in national programmes. She echoes CHANGE’s call to appropriately promote and integrate female condoms within prevention initiatives. However, she cautions, “don’t expect a success overnight”. Instead, she advocates asking what benefits female condom promotion can bring within each country context.
“Female condoms are not the magic bullet for HIV prevention”, said Sippel. Thus, both Madan and Sippel argue that female condoms require sufficient investment, alongside other HIV prevention options and those in development, such as microbicides. As the journal went to press, PEPFAR—which has provided treatment to 1·4 million people—was under debate in the US Senate. At the same time, UNITAID—an international drug purchase facility— and the Clinton Foundation HIV/AIDS Initiative announced new agreements with generic drug manufacturers to provide cheaper antiretrovirals and “affordable child-friendly formulations”, which will benefit many low-income countries.
See Leading Edge page 343 See Reflection and Reaction page 348 For more on CHANGE see http:// www.genderhealth.org For the Saving lives: female condoms and the role of US foreign aid report see http:// www.preventionnow.net
Kelly Morris 351
Since Italy introduced mandatory universal hepatitis B virus (HBV) vaccination in 1992, the incidence of infection with the virus has fallen from 5·1 per 100 000 population in 1991 to 1·3 cases per 100 000 people in 2005. “The Italian success provides additional evidence that universal HBV vaccination is efficacious and worthwhile”, said Mei-Hwei Chang (National Taiwan University Hospital, Taiwan). “These findings will encourage those few European countries who are still to convince their government that universal HBV vaccination in childhood is both feasible and desirable.” Many European countries now offer HBV universal vaccination. Notable exceptions include Denmark, Finland, Ireland, Sweden, and the UK. These countries have low endemicity but, as Jane Zuckerman (University College, London, UK) has previously noted, “Increased travel and integration of immigrant communities are increasing the number of at-risk individuals”.
The Centers for Disease Control and Prevention’s vaccination schedule in the USA incorporates universal HBV vaccination, now recommending vaccination of all children in infancy. But HBV prevalence is still high in adults of Asian origin. “Immigrants from endemic areas such as Asia may have been infected by HBV during infancy or in early childhood before they arrived in the USA”, Chang told TLID. Taiwan, like many countries in Asia, runs a successful programme: before its launch in 1984, a fifth of the population were carrying HBV. Today, only 1% of those aged below 20 years have chronic HBV and the carrier rate in children is expected to fall below 0·1%. Despite the successes, there are still 360 million chronic carriers worldwide and untreated HBV infection is the leading cause of liver-related death. “In developing countries, the proportion of HBV vaccination coverage is increasing year by year, but coverage is low because of financial constraints”, commented
Chang. Douglas Dieterich (Mount Sinai School of Medicine, New York, USA) added that HIV and HBV compound each other’s morbidities—in Asia and Africa they account for substantial liverrelated death. HBV/HIV co-infection is also a problem in the developed world, despite better availability of drug treatment. Tenofovir, the most commonly prescribed HIV medication, is just as active against hepatitis B and was approved by 27 EU member states specifically for the treatment of chronic hepatitis B at the end of April. World Hepatitis Day was marked for the first time on May 19, an initiative of the World Hepatitis Alliance (WHA), a coalition of patient groups. Their aim is to raise awareness of hepatitis B and C and to galvanise changes in global policy. The WHA is calling for WHO to endorse this new international day, as a step towards ensuring increased recognition around hepatitis.
Kathryn Senior
Adam Gault/Science Photo Library
Universal hepatitis B vaccination hailed a success in Italy
For more on the study on acute hepatitis B in Italy see Clin Infect Dis 2008; 46: 868–75; DOI:10.1086/528687 For a WHO graph showing HBV vaccine coverage see http:// www.who.int/entity/ immunization_monitoring/ diseases/HepB_coverage.jpg For more on universal HBV vaccination see Review Lancet Infect Dis 2007; 7: 410–19 For more on HIV and hepatitis B co-infection in Asia and Africa see Review Lancet Infect Dis 2007; 7: 402–09 For more on the World Hepatitis Day see http://hepccentre.org.uk
Greater interest and investment in female condoms needed As the US Congress moved in April to reauthorise the President’s Emergency Plan for AIDS Relief (PEPFAR), a report from the Center for Health and Gender Equity (CHANGE) has found that female condoms are underused and underfunded. The report, Saving lives: female condoms and the role of US foreign aid, advocates that US agencies and policy makers ensure PEPFAR-funded programmes include “access to a full range of approved prevention methods—especially those that women can initiate”, said Serra Sippel, executive director of CHANGE (Takoma Park, MD, USA). Research suggests that female condoms are effective in preventing sexually transmitted infections and as a contraceptive. “In the few countries where governments have committed to long-term http://infection.thelancet.com Vol 8 June 2008
provision of female condoms, uptake is sustained”, noted Sippel, which suggests that use depends on perceptions and promotion. However, she observes “a mismatch between attitudes in situations where female condoms are distributed compared with attitudes in the USA”. Yasmin Madan (Population Services International) explains that although the US government is the largest global provider of female condoms, there is “some degree of scepticism” about their role in national programmes. She echoes CHANGE’s call to appropriately promote and integrate female condoms within prevention initiatives. However, she cautions, “don’t expect a success overnight”. Instead, she advocates asking what benefits female condom promotion can bring within each country context.
“Female condoms are not the magic bullet for HIV prevention”, said Sippel. Thus, both Madan and Sippel argue that female condoms require sufficient investment, alongside other HIV prevention options and those in development, such as microbicides. As the journal went to press, PEPFAR—which has provided treatment to 1·4 million people—was under debate in the US Senate. At the same time, UNITAID—an international drug purchase facility— and the Clinton Foundation HIV/AIDS Initiative announced new agreements with generic drug manufacturers to provide cheaper antiretrovirals and “affordable child-friendly formulations”, which will benefit many low-income countries.
See Leading Edge page 343 See Reflection and Reaction page 348 For more on CHANGE see http:// www.genderhealth.org For the Saving lives: female condoms and the role of US foreign aid report see http:// www.preventionnow.net
Kelly Morris 351