Dear Dr Smith,
I am sorry that the news item on the prevalence of hepatitis B
infection (page 1034) is incorrect and that the accompanying artificially
coloured photograph is misleading. A negatively stained electron
micrograph has been sent under separate cover (magnification x 252,000).
It is important that the following information be provided to the
readers of the British Medical Journal:
1. More than a third of the world's population had been infected with
hepatitis B virus (WHO/12:21 February 1992)
2. It is estimated (conservatively) that there are 350 million chronic
carriers of hepatitis B virus worldwide i.e. persistently infected
individuals (WHO/12, 1992). Many are lifelong carriers, although not all
are infectious, and some clear the virus after varying intervals of many
months or years.
3. About 25% of carriers will develop serious liver disease as a result
of the infection, including chronic hepatitis, cirrhosis and primary liver
4. WHO estimates that hepatitis B results in 1-2 million deaths every
5. The WHO (European Regional Office) estimates that 1 million people are
infected in the Region each year. Of these, about 90,000 will become
chronically infected and about 22,000 will eventually die from cirrhosis
or liver cancer.
6. The sexual route is the most common means of spread of HBV in Europe
and North America. Those aged 15-24 are at the highest risk.
7. The World Health Assembly recommended in 1992 that all countries
introduce hepatitis B vaccination into national immunisation programmes by
1997. Low prevalence regions such as Europe, North America and Australia
should consider immunisation of all adolescents as an addition or
alternative to infant immunisation. This policy has been implemented by
over 85 countries and most European countries.
Professor A.J. Zuckerman
Director of the WHO Centre and Principal and Dean of the Royal Free and
University College Medical School
Competing interests: No competing interests