To the Editor.
—Dr Francis reminds us that safe and effective disease prevention technology is too often too slow in its adoption and application.1 To which we add that large-scale application of these technologies often reach those at highest risk last. Despite admirable (even heroic) progress in childhood HBV vaccination programs, the highest-risk group for HBV infection in the United States—injecting drug users (IDUs)—remain unprotected. Recent HBV seroprevalence among US IDUs has been reported in the 70% to 90% range, depending on location and such host factors as years of injection, drug of choice, and injecting practices.2 In 1995 we conducted a pilot study among 217 streetrecruited IDUs in San Francisco, Calif, and found 20% were negative for serological markers for HBV and therefore susceptible to new infections. Risk of viral infection increases dramatically in the first years following initiation into drug use. There are an estimated 1.2
Watters JK, Kral AH. Cost-effectiveness of Hepatitis B Virus Immunization. JAMA. 1996;275(12):907-908. doi:10.1001/jama.1996.03530360017019