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A cooperative effort to identify all newborn infants at risk of acquiring hepatitis B infection involving the Canadian Red Cross BTS, Health Units, hospitals, and private doctors has been in place in Alberta since 1985. Routine universal screening of all prenatal patients identifies just under 200 infected mothers per year and about 90% of their infants receive HBIG and HB vaccine in a timely manner and are protected against infection and becoming hepatitis B carriers. At least half of these infants would not be identified if a selective testing program was in place and the cost for this much less efficient policy would be at least 4 times higher. The cost per infant protected through the universal screening program is estimated to be less than $1275. Routine screening of prenatal patients for HBsAg in a public health-coordinated program is highly cost effective and efficient. It is recommended that all jurisdictions consider such a program as recommended by the ACIP unless the hepatitis B carrier state is known to be extremely rare.