Abstract Compulsory universal vaccination against hepatitis B was introduced in 1991 in Italy for all newborns and 12-year-olds. Despite the decreasing circulation of the virus noted in the late-1980s, it was clear that only universal immunization would control hepatitis B infection and limit the transmission of the virus. Data collected during the first six years after vaccination was implemented show the success of the strategy. Over 90% of infants in the country and adolescents living in north-central Italy were immunized. Since 1995, the decrease in acute cases of hepatitis B has accelerated in the age groups 0–14 and 15–24, particularly in two regions of the north; during the same period, no comparable decrease in incidence was seen in older age groups. Monitoring coverage of vaccination and incidence of acute disease and seroepidemiological studies will continue and should show a rapid progression towards the elimination of HBV circulation in the country.