Hepatitis B infection in Minnesota: a case for universal immunization.
BACKGROUND
In 1993, the Minnesota Department of Health focused on using multiple vaccination strategies to prevent the transmission of hepatitis B virus.


METHODS
Strategies aggressively pursued included the universal screening of pregnant women for hepatitis B surface antigen (HBsAg) and the universal vaccination of infants and adolescents. Universal strategies were deemed necessary because previous selective vaccination of high risk groups had failed to significantly reduce hepatitis B transmission.


RESULTS
Surveillance data showed that in Minnesota from 1994 to 1996, the universal HBsAg screening of pregnant women identified 761 infants born to HBsAg-positive women. The vast majority of these at risk infants received prophylactic treatment and were vaccinated at birth. Vaccination coverage was 78% (+/-4.2%, 95% confidence interval) for children ages 19 to 35 months who were born between August, 1993, and November, 1995. Most counties in Minnesota rarely report any cases of hepatitis B, and since 1991, less than 100 acute cases per year have been reported for the entire state.


CONCLUSIONS
The Minnesota Department of Health has demonstrated that implementation of universal hepatitis B vaccination strategies can be successful among a generally low risk population.
Acute Disease Epidemiology Section, Minnesota Department of Health, Minneapolis, USA. michael.osterholm@health.state.mn.us
M T
MT
Osterholm
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration / Q000592:standards; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration / Q000592:standards*; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008910:Minnesota / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D016730:Program Development; D011635:Public Health Administration; D012307:Risk Factors; D017678:Sex Distribution
D017325:Hepatitis B Vaccines