Letter: Heterosexuals and hepatitis B

Sir: I was surprised by the correspondence predicting an epidemic of heterosexual Aids (25 May) emphasising that hepatitis B has remained in this country uniquely as an infection of high-risk groups, such as homosexuals and intravenous drug abusers. This is incorrect.

A consultation on hepatitis B as a sexually transmitted disease was held by the World Health Organisation in November 1990. Hepatitis B, one of the major diseases of mankind, with severe consequences in terms of chronic liver disease, mortality and economic impact has been recognised since the early 1970s as an important sexually transmitted infection. In some countries in North America, Latin America and Europe, sexual transmission is the major identified mode of transmission of hepatitis B. The role of sexual transmission in areas of higher prevalence of hepatitis B is less well studied, but sexual transmission plays a significant role also in those regions.

For example, in studies in industrialised countries, heterosexual attenders of sexually transmitted disease clinics and persons with multiple sex partners have been shown to be at increased risk of hepatitis B. In the US, sexual contact is the most important mode of disease transmission, accounting for over 35 per cent of all infections and 50 per cent of cases with identified risk factors; and in recent years, the relative importance of heterosexual transmission has increased while homosexual transmission has decreased. There are no reasons to believe that the situation differs in the UK.

Hepatitis B is a sexually transmitted disease in the heterosexual (and homosexual) population and it is preventable by vaccination as well as by health education.

Yours faithfully,

ARIE ZUCKERMAN

Royal Free Hospital and School of Medicine

London, NW3

26 May

The writer is director of the World Health Organisation Collaborating Centre for Reference and Research on Viral Diseases.