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September 17, 1982

Indications for Hepatitis B Vaccine

JAMA. 1982;248(11):1310. doi:10.1001/jama.1982.03330110018013

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To the Editor.—  I wish to take exception to some of Dr Saul Krugman's recommendations for the use of hepatitis B vaccine (1982;247:2012). I believe that he has defined too broadly the high-risk groups who should now receive this unusually expensive vaccine, which, initially, will probably be limited in availability.The suggestion that classroom contacts of carriers should be vaccinated seems particularly unwarranted, although vaccination is reasonable for intimate contacts. Similarly, which physicians and paramedical personnel are at high risk of infection? The risk to a psychiatrist or to a physical therapist is certainly far less than that of a transplant surgeon. The governing principle is that immunization is appropriate for groups who demonstrate an unusual incidence of infection, which will depend on the type of contact and will also vary geographically, depending on the population being cared for by the health care personnel. It is not particularly high for