Chronic hepatitis B in children in the United States and Canada: international origins place the disease burden on children even in the era of universal vaccination

The disease burden of chronic hepatitis B is one of the most important global health concerns. To reduce the disease burden of chronic hepatitis B, in 1991, the World Health Organization (WHO) recommended the integration of the hepatitis B vaccine into the national immunization programs of countries with an hepatitis B virus (HBV) carrier prevalence of 8% or higher by 1995 and in all other counties by 1997 (1). The hepatitis B vaccine for infants was introduced nationwide in 184 countries by the end of 2014. Global coverage with 3 doses of the hepatitis B vaccine was estimated at 82% in 2014. In particular, the 3-dose coverage rate in the Western Pacific Region Office, which supports the highly endemic Asian countries, shows a rate of 92% (2). However, we are halfway to reaching the eradication of HBV.