Since the introduction of hepatitis B vaccines indications for vaccination are discussed. The New York study on homosexual men (Szmuness et al., 1980) clearly showed a high grade of protection against infection with hepatitis B virus. The same appeared to be the case in trials in dialysis units.
An advisory committee of the Netherlands Health Council raised the question which groups in the community have to be considered for vaccination. Two categories were identified. The first consists of patients who, because of special circumstances, are more susceptible than average to infection with hepatitis B virus. The second category consists of healthy persons who, because of special circumstances, are constantly or occasionally exposed to possible infection, either in a medical setting or otherwise.
To determine the order of priority for the second category criteria have to be set. An important tool for this procedure is the screening of the different subgroups on antibodies to HBsAg. This policy combines the possibilities of gaining insight into the attack rate of the virus in these subgroups and of setting up the priorities concerning vaccination. Screening of HBsAg has to be restricted to identify persons who -when positive -will endanger other individuals.