Hepatitis B vaccination coverage in Germany: systematic review

Abstract

Background Despite being considered as a low prevalence country for hepatitis B (HBV), some populations in Germany are at higher risk of infection. In the context of the World Health Organization’s (WHO) viral hepatitis elimination goals, a valid epidemiological data base is needed to plan and monitor the national response. Prevention strategies include general and targeted HBV vaccination programmes. Objective The aim of this work was to estimate the HBV vaccination coverage (VC) in the general population (GP) and different population groups in Germany from available evidence and to identify current evidence gaps for future research. Methods We conducted a systematic review on HBV VC in the general population and populations at high risk of HBV exposure or severe infection in Germany. We included eligible publications (01/01/2017 to 06/06/2020) from databases Embase, Pubmed and Livivo, from a previous scoping review (including data published 01/01/2005–17/03/2017), from the national surveillance system and screened the reference lists of all publications at full text level. Risk of bias was assessed using the Hoy et al. tool. Results We included 68 publications of 67 studies and assigned them to one or more suitable population groups. Twenty-one studies contained data among children/adolescents and three among adults from the GP (VC 65.8–90.5% and 22.9–52.1%, respectively), one among travelers (VC 89.0%), 13 among immunocompromised populations (VC 7.8–89.0%), 16 among populations with occupational risk and 16 with non-occupational risk of HBV exposure (VC 63.6–96.5% and 4.4–84.5%, respectively). Conclusion Comprehensive evidence at low risk of bias was identified for children/adolescents. However, 25 years after including HBV in the national immunisation schedule, VC in Germany is still below the 95%-goal defined by WHO. For people at occupational risk of HBV exposure, VC was mostly reported to be over the WHO goal of 80%, but quality of evidence was heterogenous and should be improved. For people at non-occupational risk of HBV exposure, evidence was sparse and of low quality. The low VC highlights the need for future research to plan vaccination programmes targeting these populations.

Protecting Frontline Nurses: What will it take? A review of policy, practice and lessons learned from High Consequence Infectious Diseases like Ebola and COVID-19

“…Across eight studies devoted to HBV, vaccine coverage among hospital staff including doctors, nurses and other medical staff found that complete vaccine coverage was suboptimal at 63.6%. 44 Another systematic review from 2011 on influenza vaccination of staff found that only three RCTs were available for review. At that time, the authors concluded that further study was needed to evaluate whether annual vaccination could be considered a key measure to protect healthcare workers.…”

The Global Impact of Hepatitis B Vaccination on Hepatocellular Carcinoma

“…Transmission in low endemicity regions, such as North America and Western Europe, occurs predominantly via sexual and percutaneous means during early adulthood [ 46 , 47 ] and vaccination is still effective at preventing transmission in adulthood. However, with increasing migration from high to low prevalence areas, adoption of universal hepatitis B vaccination is a logical public health measure [ 48 , 49 , 50 ].…”

High hepatitis B vaccination coverage among a cohort of predominantly men who have sex with men in Germany

“…In one review, vaccination coverage in Germany varied from 22.9% to 52.1% among general population adults and from 4.4% to 84.5% of adults with non-occupational risk of HBV exposure. 5 Due to a higher estimated risk for HBV infection for men who have sex with men (MSM), STIKO also recommends HBV vaccination specifically for MSM, especially those individuals who are immunocompromised due to HIV. In a prospective cohort study of people living with HIV in Germany, only 48% of MSM were vaccinated against HBV between 1996 and 2012.…”