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. 2013 Jul 29;8(7):e67866.
doi: 10.1371/journal.pone.0067866. Print 2013.

Selective hepatitis B virus vaccination has reduced hepatitis B virus transmission in the Netherlands

Susan Hahné  1 , Robin van Houdt, Femke Koedijk, Marijn van Ballegooijen, Jeroen Cremer, Sylvia Bruisten, Roel Coutinho, Hein Boot
Affiliations

Selective hepatitis B virus vaccination has reduced hepatitis B virus transmission in the Netherlands

Susan Hahné et al. PLoS One. .

Abstract

Background & aims: In 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.

Methods: We 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.

Results: 1687 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.

Conclusions: The 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Number of cases of acute HBV infection by most probable mode of transmission and year reported in the Netherlands, 2004–2010 (N = 1687).
Figure 2
Figure 2. a–c. Genotype distribution by year of reporting of acute HBV infections, the Netherlands, 2004–2010. a. Cases acquired heterosexually by men and women (n = 300); b. Cases with an unknown route of transmission acquired by men and women (n = 226) c. Cases acquired by men who have sex with men (n = 305).
Figure 3
Figure 3. Maximum parsimony tree based on the HBV S-region sequence of acute cases of HBV infection (n = 894), by most probable mode of transmission and gender, in the Netherlands, 2004–2010, and selected reference strains (n = 19).
Figure 4
Figure 4. a,b. Bayesian skyride plot: estimated genetic diversity over time of the S- and C-region sequences of genotype-A acute hepatitis-B-virus infections acquired in the Netherlands, 2004–2010.
See this image and copyright information in PMC

References

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    1. European Centre for Disease Prevention and Control (2010). Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease and screening policies. Stockholm, Sweden: ECDC. Report No.: ISBN 978-92-9193-213-9.

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