2-Dose Hepatitis Vaccination Versus 3-Dose Regimen

To the Editor.—

The study by Levaux et al¹ of adolescent hepatitis B immunization strategies has numerous limitations. First, their model ascribes greater seroprotection at regimen completion for the 2-dose regimen, despite a lack of evidence that any such difference exists. Second, the authors assume adolescents are equally likely to receive a second dose of the 2-dose regimen as a second dose of the 3-dose regimen. This is unlikely because the second dose of the 3-dose regimen is due only 4 weeks after the first, whereas the second of the 2-dose regimen is not due until 4 to 6 months after the first. Third, the assumed lifetime risk of 5% among persons age 11 to 15 years with no previous hepatitis B vaccination or hepatitis B exposure is overstated. Although they provide no reference for this estimate, all their hepatitis B clinical and economic effects derive from one previous cost-effectiveness analysis of the 3-dose regimen.² Importantly, that paper states a 4.16% risk for members of a 1991 cohort who are at least 6 years old. Furthermore, the number of reported hepatitis B infections among persons at least 15 years old has decreased from 16 980 in 1991 (L. Finelli, Centers for Disease …