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Cost rules out major hep B immunisation

The Government is set to reject growing pressure to add hepatitis B vaccine to the childhood schedule and opt instead for the cheaper strategy of targeted immunisation in high-risk groups.

The cost-based decision, signalled by the deputy head of the Health Protection Agency's immunisation division, will prove controversial.

Government vaccine advisers are split on the issue, with some calling for mass immunisation to combat the growing spread of the disease.

The World Health Organisation has also been pressing low-prevalence countries to introduce mass hepatitis B vaccination for several years.

But Dr Mary Ramsay, consultant epidemiologist and deputy head of immunisation at the agency, said adding the vaccine to the childhood schedule was too expensive and not a priority.

'If money was limitless, universal vaccination would be feasible, but a limited approach is more suitable for a cash-strapped NHS,' she said.

A 'geographically selective' policy, focusing on high-risk areas like London, was more likely, she added.

Higher priority was being given to adding other vaccines to the childhood schedule, said Dr Ramsay ­ with pneumococcal vaccine likely to come first and varicella vaccine a further possibility.

A recent study by Dr Ramsay found south Asian children in England and Wales were 10 times more likely to be infected with hepatitis B and that almost half the infections were caught overseas. She concluded hepatitis B should be added to the childhood schedule in areas with a high proportion of ethnic minorities.

A final decision on hepatitis B vaccine is due to be taken at the next meeting of an expert sub-committee set up by the Joint Committee on Vaccination and Immunisation.

Sub-committee member Dr George Kassianos, a GP in Bracknell, Berkshire, and RCGP immunisation spokesman, said he was in favour of adding the vaccine to the UK schedule. The US experience had shown it was a more cost-effective vaccine than Hib, he added.

Professor Roger Williams, professor of hepatology at University College London, said it was 'absolutely essential' to introduce a universal immunisation programme because of the dramatic increase in hepatitis B coming to the UK.

'We see 7,000 new cases a year with immigration alone,' he said. 'We're the only country that doesn't protect our children.'

But Dr Ramsay said: 'Most children are not going to be exposed to hepatitis B in their lifetime. Cost-effectiveness is the main issue here.'

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