Selective Hepatitis B Virus Vaccination Has Reduced Hepatitis B Virus Transmission in The Netherlands

Abstract

Background & AimsIn the Netherlands, a selective hepatitis B virus (HBV) vaccination programme started in 2002 for men having sex with men, drug users, commercial sex workers and heterosexuals with frequent partner changes. We assessed the programme's effectiveness to guide policy on HBV prevention.MethodsWe analysed reports of acute HBV infection in the Netherlands between 2004 and 2010 requesting serum from patients for HBV-genome S- and C-region sequencing. We used coalescence analyses to assess genetic diversity of nonimported genotype-A cases over time.Results1687 patients with acute HBV infection were reported between 2004 and 2010. The incidence of reported acute HBV infection decreased from 1.8 to 1.2 per 100,000 inhabitants, mostly due to a reduction in the number of cases in men who have sex with men. Men were overrepresented among cases with an unknown route of transmission, especially among genotype A2 cases mainly associated with transmission through male homosexual contact. The genetic diversity of nonimported genotype-A strains obtained from men who have sex with men decreased from 2006 onwards, suggesting HBV incidence in this group decreased.ConclusionsThe selective HBV-vaccination programme for behavioural high-risk groups very likely reduced the incidence of HBV infection in the Netherlands mainly by preventing HBV infections in men who have sex with men. A considerable proportion of cases in men who did not report risk behaviour was probably acquired through homosexual contact. Our findings support continuation of the programme, and adopting similar approaches in other countries where HBV transmission is focused in high-risk adults.

Phylogenetic Studies of Transmission Dynamics in Generalized HIV Epidemics

“…112 However, a follow-up study with increased sample size (n=894, versus n=85) suggested that reduced HBV transmission was in fact due to reduced incidence in MSM, highlighting the importance of sample size and extended sampling periods for studies of this type. 113 Alternatively, gene sequence data can be used to reconstruct HIV transmission networks rather than phylogenies, and cluster size distributions (CSD) can be compared over the course of a prevention trial or intervention. 59,114,115 In theory, CSDs will be dominated by larger clusters in populations where epidemic drivers (individuals with relatively high infectiousness) persist.…”

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

“…However, regional prevalence of HBV is highly variable [1] and the Netherlands is a low endemic country, with an estimated incidence of 1.2 acute HBV-infections/100,000 inhabitants in 2010 [2], and 0.2 percent of the population having chronic HBV-infections [3].…”

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“…[84][85] Moreover, a very good field for reducing the HBV burden through the HBV vaccination is concerning men who have sex with men, and Commercial sex workers, among which there exist a disproportionate burden of HBV infections. [86][87][88][89][90][91][92][93][94][95] The WHO recommendations include the offer the rapid HBV vaccination regimen for persons who inject drugs. [96][97] As far as concerns one of the strengths of this review, a gap has been filled, since it was shown the use of economic evaluations in highly endemic areas, that was lacking in previous reviews, 11 and this is very important to raise both public awareness of the effectiveness and economic attractiveness of universal immunization against HBV.…”