Postnatal horizontal transmission of hepatitis B virus (HBV) in early childhood seems to be the predominant method by which high hepatitis B carrier rates in the Middle East are maintained. The prevalence of hepatitis B surface antigen (HBsAg) positive status among siblings of HBV carriers is similar during childhood and adulthood, suggesting that childhood intrafamilial transmission patterns persist into adult life. There is a tendency for asymptomatic HBV carriers to have higher alanine aminotransferase (ALT) values, a feature that also tends to cluster in families. Infection in the first five years of life contributes most to the case load of chronic liver disease and thus to mortality from HBV. Mass hepatitis B immunisation programmes have been started, and while they may eventually reduce the HBV carrier state and liver disease loads significantly, prospects for total eradication of HBV in the near future are not good.
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