As we write, the World Health Assembly is considering a recommendation that hepatitis B (HB) vaccination be included in the routine vaccination schedule for babies or children all over the world by 1997, regardless of whether they are at high risk of contracting the disease, which can damage the liver and kill one in five carriers. The American Academy of Pediatrics has already recommended that America follow the lead of 33 countries, which have national policies on HB shots; in Italy, the jab is compulsory. In the US, the HB shot is included in the schedules for infants: in the UK, the Health Secretary has embarked upon the largest scheme of its kind since the mass smallpox immunization programme of the 1960s, recommending that adolescents on the brink of sexual activity be vaccinated against what is primarily a sexually transmitted disease.

Since 1979, when a hepatitis vaccine was released on the market, the strategy in the UK and the US has been to identify and vaccinate high risk groups, including intravenous drug abusers, the sexually promiscuous and health care workers who handle bodily fluids and blood. Despite these efforts, hepatitis cases have risen by a third between 1979 and 1989. Since the exact source of the infection is unknown, the authorities now believe we should nip it in the earliest possible bud in infants. This means they believe we should exploit the immune systems of children to prevent the spread of what is primarily a sexually transmitted disease. The recommendation in America and elsewhere is that children receive the shot with their other jabs soon after birth. Britain at least is willing to hold off until children are 12 before submitting them to a series of injections.

Amid near universal consensus about the adoption of this new policy, virtually a lone voice of dissent is our panel member,Dr J. Anthony Morris, former member of the Food and Drug Administration and the National Institutes of Health and an expert on (and now chief critic of) immunizations. On 4 May, 1992, Dr Morris presented a report to the Vaccine Safety Committee, Institute of Medicine of the National Academy of Sciences in Washington D. C. Dr. Morris and Hilary Butler, of the Immunization Awareness Society in Tuakau, in Auckland, New Zealand, compiled a report on the experience of the New Zealand authorities, one of the first to adopt a wholesale programme of HB vaccination of all newborn babies in seven districts of the country as they put it, the "most extensive national immunization programme in the world".

Morris and Butler's report, "The Nature and Frequency of Adverse Reactions following the Hepatitis B vaccine injection in Children in New Zealand from 1985-88", is the first to track the reported side effects of the BH vaccine in one country over three years, and also the first to provide a fairly comprehensive list of reported side effects from the shot. Dr Morris shared this report with me in the hope that it would help our readers. What follows is a virtual copy of the report in its entirety, with minor edits made to decipher medicalese.

Plasma derived hepatitis B vaccine was licensed for use in the United States in 1981. Before it was given a licence, the most common side effects in adults in trials of pre licensed hepatitis B vaccines (derived from human blood plasma) were soreness at the injection site and mild dizziness, according to the Centers for Disease Control report published in the Morbidity and Mortality Weekly Report on 7 June 1985. Four years later, results of a post marketing surveillance study published in the American Journal of Epidemics 1988 (127: 337-352) showed that among an estimated 750,000 recipients of the early vaccine, only about 100 episodes of severe illness were reported.