Selective risk group strategies in Europe.

Most countries in northern and western Europe belong to areas with a low endemicity of hepatitis B virus (HBV). When HBV vaccines became available, these countries adopted a vaccination strategy that targeted groups at high risk of hepatitis B. However, it became obvious that this strategy, despite giving good protection to those who had been vaccinated, had largely failed. This was firstly because, with few exceptions (e.g. haemodialysis patients and haemophiliacs), only medical and dental workers were vaccinated in any great numbers, whereas only a few individuals in other risk groups were reached. Second, it was found that less than half of all hepatitis B cases occurred in individuals in typical high-risk groups. In Germany, for example, about three-quarters of all infections occur in people who would never be reached by the high-risk vaccination strategy, most of these individuals having been infected by heterosexual contact. Thus a universal vaccination strategy has to be implemented to control the spread of hepatitis B in the population and to eventually eliminate the disease.