To the Editor.
—Dr Margolis and colleagues1 seek to determine the most cost-effective way to protect a single birth cohort from HBV over the course of their lives. They answer the question: "What is the best strategy to reduce hepatitis B infections 30 years from now?" But they do not fully address the problem: "What is the best strategy to fight hepatitis B infections among all ages today?"The answer to the latter problem certainly includes both universal infant and adolescent immunization, as Margolis et al suggest in their discussion. But equally important is a third strategy: renewed emphasis on vaccinating older adolescents and adults who have risk factors for imminent HBV infection. Such risk factors include a history of more than two sexual partners in the last 6 months, a recent sexually transmitted disease (STD), or intravenous drug use.2Aggressive strategies for finding and vaccinating these high-risk
Sharfstein J, Wise P. Cost-effectiveness of Hepatitis B Virus Immunization. JAMA. 1996;275(12):908. doi:10.1001/jama.1996.03530360017021