Selective hepatitis B virus vaccination has reduced hepatitis B virus transmission in the Netherlands.
OBJECTIVE
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.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. susan.hahne@rivm.nl
Susan
S
Hahné
Robin
R
van Houdt
Femke
F
Koedijk
Marijn
M
van Ballegooijen
Jeroen
J
Cremer
Sylvia
S
Bruisten
Roel
R
Coutinho
Hein
H
Boot
D000328:Adult; D001483:Base Sequence; D001499:Bayes Theorem; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D009426:Netherlands / Q000453:epidemiology; D014611:Vaccination
D017325:Hepatitis B Vaccines