title: Broader vaccination of expatriates against HBV infection: do we reach those at highest risk?
abstract: BACKGROUND
  The effects of the implementation of a new Dutch hepatitis B virus (HBV) vaccination strategy (1991) for expatriates on HBV vaccination status and HBV infection prevalence were evaluated in a group of 864 expatriates returning from HBV-endemic areas.
  
  
  METHODS
  During a routine medical examination at the participating medical centres Dutch expatriates were asked to complete a questionnaire and to donate a serum sample for HBV testing. Blood was tested for antibodies against the hepatitis B core (anti-HBc) and surface antigens (anti-HBs). The serological data were related to information gathered on aspects of residence, sexual risk behaviour and occupational risks.
  
  
  RESULTS
  A significantly higher percentage of expatriates (37%) were vaccinated compared to a previous study in 1987-1989 (14%). However, the percentage of expatriates with HBV infection markers (5%) had not decreased significantly. Moreover, the risk for HBV infection, as determined with a questionnaire, was still affected by well-known risk factors such as homosexual contacts (odds ratio [OR] = 6.6, 95% CI: 1.7-26), more than five casual local partners (OR = 3.6, 95% CI: 1.2-11) and more than five occupational accidents in the last 3 years (OR = 20, 95% CI: 2-187). Detailed analysis of the vaccination status indicated that especially young female expatriates with low risk behaviour (65%) were protected, while older male expatriates with high risk behaviour were less protected (20%).
  
  
  CONCLUSIONS
  We conclude that the new vaccination strategy has resulted in a higher percentage of expatriates protected. However, only a small proportion was reached of those at highest risk for HBV infection.
authors.affiliation: Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. wim.goettsch@rivm.nl
authors.forename: W
authors.initials: W
authors.lastname: Goettsch
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.forename: J W
authors.initials: JW
authors.lastname: Dorigo-Zetsma
authors.forename: G
authors.initials: G
authors.lastname: van Zessen
authors.forename: H
authors.initials: H
authors.lastname: Houweling
mesh_terms: D000328:Adult; D000349:Africa; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007843:Latin America; D008297:Male; D009426:Netherlands / Q000453:epidemiology / Q000208:ethnology; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control; D011159:Population Surveillance; D015995:Prevalence; D018570:Risk Assessment; D012309:Risk-Taking; D012698:Serologic Tests; D012747:Sexual Partners; D013997:Time Factors; D014195:Travel; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D017325:Hepatitis B Vaccines