Outcomes: Progress in the Hepatitis B Fight

By JOHN O'NEIL

n the 20 years since a vaccine against hepatitis B was introduced, new infections in the United States have dropped to 80,000 a year from more than 200,000, according to the Centers for Disease Control and Prevention in Atlanta.

The number of children infected each year has dropped even more sharply, according to an article in the agency's journal, The Morbidity and Mortality Weekly Report.

In 1986, 9 children out of every 10,000 between the ages of 1 and 9 were newly infected; in 2000, that figure dropped to 1 per 10,000.

The article called the reduction in the incidence of hepatitis B a significant public health achievement, though not one that came without controversy.

Hepatitis B can cause cirrhosis and liver cancer.

The initial vaccination recommendation, in June 1982, had been limited to three groups considered at high risk for exposure: men who have sex with men, intravenous drug users and heterosexuals with multiple sex partners.

But relatively few of them received the shots.

So in 1991, the guidelines were expanded to cover all children; in 1995, vaccinations were also recommended for all 11- or 12-year-olds who had not received shots. With new programs to screen pregnant women, the rate of transmission to newborns fell 75 percent from 1987 to 2000.

Along the way, concerns were raised over whether versions of the vaccine could cause H.I.V., multiple sclerosis or exposure to harmful levels of mercury.

The article said reviews found no evidence to support those worries, but last year the vaccine's manufacturers removed the mercury that was used as a preservative.

The article said the greatest challenge to ending the spread of hepatitis B was the one the program began with: vaccinating adults at high risk for infection.