Studies in high- and intermediate-prevalence areas have also shown that the risk of horizontal transmission of HBV in the household occurs prior to and during school years between the ages of 7 and 11 years. Horizontal transmission is more common in countries where there is a high or intermediate prevalence of hepatitis B infection and families with origins in such countries may experience a higher incidence of both acute and chronic infection than the general population. In low-endemicity countries, prevalence is higher in migrant populations. The extent of horizontal transmission in the UK, particularly during early childhood, is unknown. Most new infections acquired in the UK, a low-prevalence country, are believed to occur in adults primarily via injecting drug use or sexual transmission. Such programmes, however, cannot prevent horizontal transmission of the virus in early childhood. Infections in adult risk groups can be targeted by selective immunization programmes or by universal adolescent immunization. In low-prevalence countries, however, perinatal transmission can be largely prevented by universal antenatal screening and targeted immunization of neonates. Universal infant immunization has decreased rates of HBV infection in a number of high-prevalence countries. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.Ĭhronic infection with hepatitis B virus (HBV) affects over 350 million individuals worldwide and is the leading cause of hepatocellular carcinoma and liver cirrhosis. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5♰0 and 12♴9/100 000. The estimated average annual incidence of hepatitis B was estimated to be 29♲6/100 000 children (95% CI 16♰0–49♰8). The overall prevalence of anti-HBc in children was low. Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. ![]() Oral fluid specimens were collected from schoolchildren aged 7–11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants.
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