National infrastructures for delivery of hepatitis B vaccination to different age groups.

If hepatitis B vaccination is to be introduced into a universal vaccination programme, it must be given before young people become sexually active. Two age groups are of main interest: infants and early adolescents. In Australia, North America and Europe, vaccination programmes for infants are well established but not yet for adolescents. From a developmental point of view, targeting adolescents seems to be a demanding task. Nevertheless, there are examples of successful approaches: e.g. rubella vaccination in the UK, where since its introduction in 1976 the immunization coverage among 14-year-olds has remained high at 80-85%, or the more recent hepatitis B strategies in Italy and Spain, where young adolescents are included with high success rates. In summary, whereas the inclusion of HBV vaccine in the infant immunization programme is not a problem in most counties, the approach to adolescents needs more thought.