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March 27, 1996

Cost-effectiveness of Hepatitis B Virus Immunization-Reply

Author Affiliations

Centers for Disease Control and Prevention Atlanta, Ga

JAMA. 1996;275(12):909. doi:10.1001/jama.1996.03530360017022

In Reply.  —We agree with Dr Edmunds and colleagues that ongoing immunization will ultimately lower the risk of HBV infection in a population. Modeling the dynamics of infection risk into evaluations of immunization strategies would provide better assessment of long-term prevention effectiveness. However, few such analyses exist, making cost comparisons with other infectious diseases difficult. We have dynamically modeled the expected reduction in HBV infection associated with various immunization strategies in populations with varying endemicity of infection (P. J. C., unpublished data, 1995). In populations in which infections occur predominantly during early childhood (eg, Gambians and Alaskan Natives), infant immunization combined with catch-up immunization of young children would dramatically reduce infection risk in a decade. In such a setting, the force of infection resides in a limited young age group and is rapidly eliminated by immunization. However, in low-endemicity populations, most infections are transmitted among young adults over a wide