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To the Editor: About 387 million people (over 5% of the global population) are chronically infected with the hepatitis B virus (HBV).1 The World Health Organization (WHO) plans to contain the burden of HBV infections by means of universal vaccination programmes for infants and adolescents. The vaccine may be almost universally available to children within the next few years.2 A major drawback of monitoring immunity to the hepatitis B vaccine or HBV infection is the need for a blood specimen to detect hepatitis B surface antibodies (antiHBs). Collecting blood is by needle, and is often painful and traumatic for babies, children and adults with poor venous access, so non-invasive sampling would be an ideal alternative. Several oral fluid collection devices exist.3-7 The OraSure (OraSure Technologies Inc., USA), a non-invasive cotton pad impregnated with gelatine, salts (sodium chloride, citric acid, sodium benzoate, potassium sorbate, and sodium hydroxide to give pH 6.5) and deionised water is approved for use in humans by the USA’s Food and Drug Administration (FDA) and is licensed for collection of oral mucosal transudate (OMT) for anti-HIV testing.8 As OMT is a serous fluid rich in immunoglubulins (IgG, IgM and IgA), it is possible to test for antibodies induced by infections of public health importance such as hepatitis A virus (HAV), HBV, hepatitis C virus (HCV),7,9,10 human papillomavirus type 1611 and many others.6 Samples can also be used to investigate the presence of hepatitis B surface antigen.12

Oral fluid detection of hepatitis B vaccine-induced antibodies can improve vaccination programmes.