title: [Hepatitis B virus transmission patterns in the Netherlands, 2004].
abstract: OBJECTIVE
  To gain insight into hepatitis B virus (HBV) transmission in the Netherlands.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  During 2004, epidemiological data and blood samples (if available) were collected for all reported cases of acute HBV infections in the Netherlands. Following DNA isolation and amplification a 648 base pairs fragment of the HBV S gene was sequenced and subjected to phylogenetic analysis. The sequencing details were also linked to epidemiological information.
  
  
  RESULTS
  In 2004, 291 cases ofacute HBV infections were reported. Blood samples were received from 171 patients (59%), and the genotype could be determined for 158 patients (54%). 6 genotypes were identified: A (64%), B (3%), C (3%), D (21%), E (5%) and F (4%). Of all patients with genotype A, 52% had been infected via homosexual or bisexual contact and 16% via heterosexual contact. Of all patients with genotype D, 42% had been infected via heterosexual contact and 15% via homosexual or bisexual contact. The genotype A cluster was extremely homogeneous with many identical sequences, while genotype B-E clusters were more heterogeneous. 4 identical sequences were found within genotype F, but the patients could not be epidemiologically linked.
  
  
  CONCLUSIONS
  Sexual transmission, particularly via homosexual or bisexual contact in men, formed the most important risk factor for acquiring an acute HBV infection. Genotype A was predominant in the Netherlands, especially among homosexual or bisexual men. Most infections within genotype D occurred as a result of heterosexual contact. The results show that there was ongoing transmission of HBV in homosexual or bisexual men, while in heterosexuals more cases of new introduction were seen, possibly via chronic carriers from areas where HBV is endemic.
authors.affiliation: Rijksinstituut voor Volksgezondheid en Milieu, Postbus 1, 3720 BA Bilthoven.
authors.forename: F D H
authors.initials: FD
authors.lastname: Koedijk
authors.forename: R
authors.initials: R
authors.lastname: van Houdt
authors.forename: E L M
authors.initials: EL
authors.lastname: Op de Coul
authors.forename: N H T M
authors.initials: NH
authors.lastname: Dukers
authors.forename: H G M
authors.initials: HG
authors.lastname: Niesters
authors.forename: M C
authors.initials: MC
authors.lastname: Mostert
authors.forename: J H
authors.initials: JH
authors.lastname: Richardus
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
authors.forename: G J J
authors.initials: GJ
authors.lastname: van Doornum
authors.forename: J A R
authors.initials: JA
authors.lastname: van den Hoek
authors.forename: M J W
authors.initials: MJ
authors.lastname: van de Laar
authors.forename: R A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: S M
authors.initials: SM
authors.lastname: Bruisten
authors.forename: H J
authors.initials: HJ
authors.lastname: Boot