High risk groups are still not being vaccinated

Editor—Aggarwal and Ranjan highlighted the global burden of hepatitis B and say that vaccination is the mainstay of prevention.¹ They also describe the vaccination's lifelong efficacy and cost effectiveness. With such a clear evidence base and the recognition that certain high risk groups—such as injecting drug users—must be vaccinated, the availability of vaccination services to this population is disappointing.

In a recent national survey of all UK drug treatment agencies, only a quarter of drug services routinely provided hepatitis testing and vaccination for hepatitis B, and a quarter did not offer this service at all.² Often associated with equally limited access to hepatitis C testing, the absence of such service provision not only needlessly exposes vulnerable individuals to preventable risk but also denies the chance for positive behavioural change that can be seen in those who are made aware of their viral status.

The authors say that, in preference to universal neonatal vaccination adopted in countries with higher prevalence, a policy of selective immunisation of high risk groups has been implemented in the United Kingdom. However, a large proportion of injecting drug users in contact with treatment agencies who should thus be ideally placed to access and receive such interventions clearly do not. The continued failure to institute such health and cost effective evidence based interventions to a marginalised and high risk group is unacceptable and inconsistent with UK policy and the expectation of reasonable public health care and harm reduction.