Editorial Commentary: Surveillance of the Molecular Epidemiology of Hepatitis B Virus in Industrialized Countries: Necessary Despite Low Prevalence and an Available, Effective Vaccine?

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Abstract
Hepatitis B virus (HBV) infection is a major global health problem. The World Health Organization (WHO) estimates that ∼2 billion persons are infected worldwide, including 350 million carriers of chronic HBV infection [1]. In industrialized countries, the prevalence of HBV infection is low. After a highly effective vaccine was implemented in these countries in the early 1990s, the incidence of acute HBV infection decreased significantly; for example, in the United States the incidence of infection decreased from 8.5 per 100,000 population to 2.8 per 100,000 population during a 12-year period [2]. However, outbreaks of HBV infection still occur, particularly in at-risk groups, such as injection drug users, persons with sexually promiscuous behaviour, and prison inmates, which reflects the poor vaccination coverage among these groups [2]. An outbreak of infection leads to an amplification of specific HBV strains. These viral strains may have increased pathogenic potential, thereby inducing, for instance, a high rate of fulminant hepatitis B [3]. Also, HBV variants with escape of vaccine-induced immunity may be selected during an outbreak [4]. Therefore, continuous surveillance of the spread of HBV strains is necessary.