Striving for universal birth dose hepatitis B vaccination in Canada: data from Ontario make a compelling case.

In 2009, the World Health Organization called for global universal birth dose hepatitis B virus (HBV) vaccination; however, in Canada, five provinces still vaccinate adolescents. The National Advisory Committee on Immunization (NACI) recommends province-to-province assessment of local epidemiology and states that if there is a failure of the routine immunization program, as indicated by HBV infection occurring in infants and children awaiting vaccination, that changes should be made. It has now been shown in Ontario that children under the age of 12 who are born in Canada are acquiring HBV prior to adolescent vaccination. In regions where birth dose vaccination was implemented decades ago, there is a lower adult HBV prevalence. In addition, birth dose vaccination has been shown to be cost-effective in Canada. With these data, we strongly encourage NACI to provide a uniform Canadian recommendation, for provincial public health policymakers to move to universal birth dose vaccination, and for providers to offer universal vaccination accross Canada.