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Vaccine. 1998 Nov;16 Suppl:S3-6.

From Cannes 1993 to the present.

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Centre for the Evaluation of Vaccination, University of Antwerp, Belgium.


In 1993 the Viral Hepatitis Prevention Board focused its attention on the serious threat hepatitis B poses to the community at large. The Cannes 1993 meeting "Action Towards Control of Hepatitis B as a Community Health Risk" was the first initiative and the springboard for other activities. The rationale behind universal hepatitis B vaccination strategies and the prerequisites for implementing these strategies were analyzed. Background information on country-specific hepatitis B epidemiology and on the feasibility of vaccination strategies were presented and discussed. The congress participants concluded that it is insufficient and ineffective to focus a vaccination campaign on a limited subset of the population (the so-called 'risk groups'), and the need for universal hepatitis B immunization was clearly recognized. Since Cannes 1993 many countries have responded to the call for universal hepatitis B immunization. Many have performed economic evaluation studies, while others have initiated sero-epidemiological studies to generate input data for burden of disease calculation. These studies indicate that epidemiological and economic arguments cannot be used to delay the implementation of universal hepatitis B vaccination. Some countries have improved their surveillance systems and included viral hepatitis in the surveillance programmes. Others have put hepatitis B on the political agenda. Where are we now? In the six years since the Global Advisory Group of the Expanded Programme on Immunization set 1997 as the target for integrating HB vaccination into national immunization programmes world-wide, more than 90 countries have included hepatitis B vaccine as part of their routine infant or adolescent immunisation programmes. In the WHO European Region, Albania, Bulgaria, France, Germany, Italy, Luxembourg, Moldova, Poland, Portugal, Romania, Andora, Austria, Greece, Malta, Switzerland, Israel, Slovenia and Spain have implemented universal vaccination programmes. Belgium, the Netherlands and several other European countries are seriously studying the issues or are making budgetary provisions for the introduction of HB into their vaccination programmes. Most of the European countries which now use the vaccine routinely have started with adolescent immunization. Italy and France have begun with both adolescent and infant HB immunization. The rewards of effective implementation of immunization programmes in these countries are becoming apparent and their success offers an exemplary model for other countries. The deadline was 1997! In Europe, work remains to be done before interventions, that will bring us closer to the WHO goal of universal immunization and to the goal of controlling hepatitis B in the community, are implemented. To this end, the VHPB has continuously supported the efforts of countries in Europe to meet the WHO target by convening meetings of international experts and issuing publications on the prevention and control of viral hepatitis.

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