A colleague working at a nearby desk groaned the other day. I asked why, and he told me that he’d just received a laboratory notification for a child who had been identified as needing a course of neonatal hepatitis B vaccine. It appeared that the system had failed, the vaccination hadn’t been completed, and the child had become infected. Selective vaccination is not totally reliable.

So, should we have a universal vaccination programme? Before answering, we need to know:

• How important is the disease that you would prevent?

• How much of the disease would a universal vaccination programme prevent?

• What would be the costs of a vaccination programme?

• What costs would the vaccination programme prevent?

• How do the costs of the programme compare with the costs prevented?

If the costs saved exceed the costs of vaccination, the programme is worth introducing. That’s the principle—in practice getting clear answers can be difficult, and the answers don’t remain static.

Acute hepatitis B infection is usually asymptomatic; in a minority it is prolonged, serious, and occasionally fatal. Of those infected, 90% of infants infected at birth, 25–30% of 1–4 year olds, and 3–5% of individuals aged 5 years or more will proceed to having chronic hepatitis B (CHB). Some of those with CHB will be infectious, and some will develop cirrhosis, and/or hepatocellular carcinoma years or decades later. Each year in the UK there are an estimated 4300 acute hepatitis B infections, more than 7500 new cases of chronic infection with hepatitis B (mainly in immigrants), and up to 430 cases of hepatitis B related hepatocellular carcinoma, with estimated NHS costs of £26m–£375m.¹

Hepatitis B can be safely and effectively prevented by vaccination.² The UK offers targeted vaccination for hepatitis B to people in particular risk groups, as …