[Risk-benefit assessment of hepatitis B vaccination in France, 2006].
OBJECTIVE
Rare and unexpected adverse events following hepatitis B immunization have been reported. This article aims to illustrate the risk-benefit assessment of hepatitis B immunization strategies, using the available evidence in medical literature.
i) Hepatitis B vaccination efficacy is high in infants, children and adolescents. It may be lower in adults and at risk populations; ii) Hepatitis B descriptive epidemiological data in France are scarce, fragmental, unprecise and changing according to the studied population strata. The incidence of symptomatic cases in the general population is below 5 per 100,000 since the year 2000. In France, it is estimated that about 300,000 adults are carriers of HBs antigen, and thus able to transmit the disease; iii) The actual French pharmacovigilance signal and the epidemiological studies may suggest the hypothesis of an association between the occurrence of central nervous system demyelinating diseases and hepatitis B vaccination. If this association exists, the relative risk is probably of less than 3.


CONCLUSIONS
The lack of accuracy of risks estimates complicates the risk-benefit assessment of hepatitis B vaccination. Its perception is then influenced and distorted by subjective factors, underlying the need for research in communication about benefits and risks of immunizations. Although still debated, the hypothesis of a putative role of hepatitis B vaccine in the pathophysiology of demyelinating diseases should prompt to pursue experimental and epidemiological research to better understand the links between infectious environment and inflammatory chronic diseases.
Hanslik
T
T
Inserm U707, épidémiologie, systèmes d'informations, modélisation, université Pierre et Marie-Curie, Paris, France. thomas.hanslik@apr.aphp.fr
Valleron
A-J
AJ
Flahault
A
A
D000328:Adult; D002353:Carrier State; D005602:France / Q000453:epidemiology; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000009:adverse effects; D006801:Humans; D007114:Immunization / Q000009:adverse effects / Q000706:statistics & numerical data*; D015994:Incidence; D018570:Risk Assessment
D017325:Hepatitis B Vaccines