How AIDS forces reappraisal of hepatitis B virus control in sub-Saharan Africa.

For developing countries the cost-benefit of vaccination in the control of hepatitis B virus (HBV) infection is great since the acute infection is generally subclinical and the benefit is the prevention of small numbers of cases of cirrhosis and hepatocellular carcinoma. Since the pattern of HBV infection in Africa is such that, compared with south-east Asia, infection occurs later in childhood and spread is horizontal rather than vertical, investigation of the method of spread of HBV may result in a means of control other than by vaccination. In the meantime, because of the overlap in the means by which HBV and human immunodeficiency virus (HIV) are spread, it could be worthwhile taking advantage of existing AIDS prevention programmes to educate people about how to avoid both HBV and HIV infections.