Vaccination against hepatitis B in low endemic countries

Kretzschmar, Mirjam; Wit, G. Ardine de; Smits, Luc; Laar, M J W van de

doi:10.1017/s0950268801006562

Cited by 47 publications

(35 citation statements)

References 8 publications

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“…The nurses, however, were well trained for this type of survey. Kretzschmar et al [2002] acknowledges the problem of self-reported data on sexual behavior, and refers to a large survey conducted in The Netherlands on sexual behavior that includes 1,001 respondents [Zessen and Sandfort, 1991]. These studies suggest that surveys taken by experienced nurses are optimal ways of obtaining data on sexual behavior.…”

Section: Discussionmentioning

confidence: 99%

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Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

Toy

Veldhuijzen

Mostert

et al. 2008

Journal of Medical Virology

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The Netherlands is a low endemic country for hepatitis B virus (HBV). Rotterdam, a city in The Netherlands harbors a large group of chronic hepatitis B (CHB) patients of which most are born abroad. The study included 464 consecutive CHB patients who were reported to the Municipal Public Health Service in Rotterdam from January 1, 2002 to September 15, 2005. The HBV genotypes, possible transmission routes of infection and travel history of CHB patients born in The Netherlands, were compared with those CHB patients living in The Netherlands but who were foreign-born, taking into account the ethnicity of the mother. Of the 464 patients with CHB infection, 14% were Dutch-born and 86% were foreign-born. The CHB patients in the Dutch-born group had genotypes A (35%), B (15%), C (11%), D (37%), and G (2%). In the foreign-born group, the distribution of genotypes was A (20%), B (15%), C (11%), D (40%), and E (15%). In the Dutch-born group, sexual transmission accounted for a larger proportion of infections (P < 0.0001) compared to the foreign-born group, whereas perinatal transmission is reported to be higher in the foreign-born group and in the Dutch-born group with a foreign mother. The genotypes of the chronic HBV strains determined corresponded well with the HBV genotypes expected from the countries of origin of the patients or their mothers. Genotypes A and D are predominant in CHB patients in The Netherlands.

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Section: Discussionmentioning

confidence: 99%

“…In a large part of the general population, the virus cannot maintain itself without the import of new cases from the outside [Kretzschmar et al, 2002]. Import is observed, primarily through contacts (e.g., intermarriage) with the migrant population.…”

Section: Discussionmentioning

confidence: 99%

Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

Toy

Veldhuijzen

Mostert

et al. 2008

Journal of Medical Virology

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“…In the Netherlands this was found to be not costeffective due to the very low HBV-carrier prevalence and the relative high percentage of imported HBV-infections [5,6]. Introduction was therefore postponed until 2011 [7].…”

Section: Introductionmentioning

confidence: 99%

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

Mangen

Stibbe

Urbanus

et al. 2017

Vaccine

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a b s t r a c tBackground: The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. Methods: Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002-2006 and 2007-2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections -as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. Results: The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. Discussion and conclusion: This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per riskgroup, increase effects or when to integrate the vaccination in regular healthcare.

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“…The reproductive number for HBV infection was estimated at 0.69-1.11 in the low endemic areas of the Netherlands and UK (Kretzschmar et al 2002). In these areas, the HBV transmission route was environmental with horizontal transmission, and the spread of HBV infection was therefore lower in their countries than our study because vertical transmission was rampant in Taiwan, particularly in southern area.…”

Section: Discussionmentioning

confidence: 53%

Stochastic model for hepatitis B virus infection through maternal (vertical) and environmental (horizontal) transmission with applications to basic reproductive number estimation and economic appraisal of preventive strategies

Hung

Wang

Yen

et al. 2013

Stoch Environ Res Risk Assess

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Elucidating the temporal natural history of Hepatitis B virus (HBV) infection provides not only useful information for assessing the spread of HBV infection but also a bedrock for economic appraisal of population-based preventive strategies (such as universal vaccination). HBV transmissions are transmitted through the maternal (vertical) route and environmental (horizontal) route. As the infection process from susceptible to active virus replication and finally to recovery state or to carrier state through both routes is not directly observable, mathematical models were therefore proposed to quantitatively elucidate the dynamic process of HBV infection with time. We began with a simple two-state model (from susceptible to infection) and further developed a five-state (including susceptible, latent phase, active viral replication, carrier, and recovery states) stochastic process to quantify the dynamics of HBV infection, making allowances for a mixed proportion of vertical and horizontal transmissions. The data used in the estimation, which were collected before implementation of a policy for universal HBV vaccination, were derived from several previous serum prevalence studies, including both low (northern) and high (southern) HBV prevalence areas, in Taiwan. The parameters obtained from stochastic models were converted to compute the basic reproductive number (R 0 ) in each study to indicate the extent of the spread of HBV infection. By linking the temporal natural history of HBV infection with the previously established Markov process for the sequelae of HBV infection (chronic hepatitis infection, liver cirrhosis, and hepatocelluar carcinoma), we developed a Markov cycle decision tree to evaluate the two populationbased preventive strategies related to vaccination and maternal lamivudine use with a cost-effectiveness analysis. In the five-state model, horizontal transmission was found to contribute more to HBV infection than vertical transmission in the northern area (59 vs. 41 %), whereas vertical transmission was more likely than horizontal transmission in the southern area (80 vs. 20 %). After considering the parameters of the two transmission routes, annual infection rate (person-years) for susceptible subjects was higher in the northern area (0.35) than the southern area (0.011). A similar finding was noted for annual rate of the transition from the latent period to active viral replications (1.12 in the northern area and 0.072 in the southern area). Annual rate of the conversion from active viral replication to the carrier state was higher in the southern area (0.184) than the northern area (0.119). Annual recovery rates were 0.014 in the northern area and 0.024 in the southern area for the carrier and 0.048 and 0.088 for transient viremia. The R 0 at age 30 using the parameters obtained from the five-state stochastic model was estimated as 4.88 in the northern and 7.03 in the southern area. Regarding the findings of economic appraisal, both preventive strategies were cost-saving, yielding the n...

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Vaccination against hepatitis B in low endemic countries

Cited by 47 publications

References 8 publications

Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

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

Stochastic model for hepatitis B virus infection through maternal (vertical) and environmental (horizontal) transmission with applications to basic reproductive number estimation and economic appraisal of preventive strategies

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