Impact of Immunization Initiatives on Acute Hepatitis B Incidence in North Carolina (1991-2005)

Prepared by Patricia Poole, RN, Hepatitis B coordinator, NC Immunization Branch, and Jean-Marie Maillard, MD, MSc, medical epidemiologist, General Communicable Disease Control Branch.

Hepatitis B is a disease caused by a highly infectious virus. It can lead to severe illness, liver damage and, death. Each year in the United States, more than 80,000 people become infected with hepatitis B virus. Many newly infected persons develop life-long infection and have higher risks of liver-related complications. Hepatitis B complications cause approximately 5,000 deaths due to liver failure and another 1,500 deaths due to liver cancer each year in the United States. Hepatitis B virus is the most common cause of liver cancer in the world today.

Infected persons often do not have symptoms and may not be aware they are infected; however, they are capable of infecting others. Hepatitis B virus can be passed from one person to another through exposure to blood and other body fluids. Disease may be spread from an infected person to another person in the following ways:

• Having unprotected sex (without using a condom)
• During birth from an infected mother to her newborn infant
• Contact with blood or open sores of an infected person
• Sharing personal items such as razors, nail clippers or tooth brushes
• Using non sterile needles in body or ear piercing, injecting drug use, tattooing, or acupuncture

Since 1990, North Carolina state law requires vaccination of infants born to infected women. In 1994, North Carolina became a universal state, providing hepatitis B vaccine to all children at no cost. Additionally, state immunization law requires the hepatitis B vaccination series for all children born since July 1, 1994.

In 1995, North Carolina launched a statewide initiative to offer hepatitis B vaccinations to susceptible sixth graders in on-site school clinics. This strategy was implemented to provide protection to unvaccinated children prior to the age when they may become sexually active or experiment with illicit drugs.

Since the program began, the number of reported new cases of hepatitis B in North Carolina has declined by 77 percent. (Figure 1.) The greatest reduction in cases has been among people 19 and younger, who have experienced a 91 percent decline. The number of cases in people 20 and older declined by 75 percent. (Figure 2.)

Immunization efforts have successfully reduced the number of acute hepatitis B cases in North Carolina. This reduction in newly infected people means there will be fewer chronic liver infections, thus reducing risks of exposure and reducing complications from hepatitis B disease. The full effect of the reduced number of acute hepatitis B infections will become more evident as vaccinated infants and children advance in age. The public health benefit of this immunization program will bring immeasurable dividends for years to come.

For more information about the North Carolina Hepatitis B Prevention Program, contact: Patricia Poole, R.N., North Carolina Immunization Branch, at 919.707.5573.

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Last Modified: May 5, 2006