Book Review

Hepatitis B Vaccines in Clinical Practice

N Engl J Med 1993; 329:1514November 11, 1993

Article

Hepatitis B Vaccines in Clinical Practice
Edited by Ronald W. Ellis. 418 pp., illustrated. New York, Marcel Dekker, 1993. $155. ISBN: 0-8247-8780-3

What an unfortunate title for an excellent monograph. This multiauthored book provides broad coverage of all aspects of the study of vaccines against hepatitis B virus (HBV). Only 4 of the 20 chapters relate to the use of these vaccines in clinical practice.

The chapters range from reviews of the biochemistry of HBV proteins and a detailed discussion of T- and B-cell epitopes of the PreS and surface-antigen regions, to descriptions of available HBV vaccines and those under development, the design and results of clinical trials, the epidemiology of HBV infection, HBV variants, strategies for global control of HBV infections, and finally, guidelines for the use of the vaccine in clinical practice.

Had this book been more broadly titled, it would have been more accessible to those interested in the scientific basis of HBV vaccines. For this readership, this monograph will be an invaluable reference.

Maurice Hilleman, a pioneer in the field, has contributed an excellent review of the development of the first generation of HBV vaccines, which were derived from human plasma. It is unfortunate that he concludes that this vaccine has been rendered obsolete by the development of yeast recombinant vaccines. Plasma-derived vaccines are still the most widely used HBV vaccines -- 45 million doses have been given in China alone. These vaccines are likely to have a major continuing role in controlling hepatitis B in developing countries because of the low cost of these vaccines as compared with recombinant vaccines.

Despite the uniformly high quality of individual chapters, there is considerable overlap and repetition. HBV escape mutants, for instance, are discussed in some detail in three of the chapters.

Overall, this is an excellent addition to the libraries of those with an interest in HBV vaccines.

Alfred M. Prince, M.D.
New York Blood Center, New York, NY 10021