Heterosexual Transmission of Hepatitis B virus: A Public Health Perspective
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AbstractGiven the objectives of the medical aspects of public health, the 'heterosexual transmission' approach may be restrictive and too conventional as it considers transmission only through two individuals of different sexes and only by peno-vaginal penetration, to the exclusion of all other sexual activities. Bloodborne disease transmission in intravenous drug users must be considered as well as anal transmission of this disease. Three sine qua non conditions must be met before public health interventions are initiated: the disease agent must be known or presumed; a causal relationship must exist between the agent and disease; and the proposed intervention must be both pertinent and effective. The first two conditions have been established in the case of hepatitis B virus infection. The latter condition, however, has proven difficult to fulfill. It must be determined whether the approach of immunizing all infants, drug addicts and prostitutes is cost effective and accepted by a moral society. Consideration must be given to all possible modes of transmission in order to develop an effective public health strategy to combat hepatitis B.