title: Targeted vaccination programme successful in reducing acute hepatitis B in men having sex with men in Amsterdam, the Netherlands.
abstract: OBJECTIVE
  In the Netherlands, transmission of hepatitis B virus occurs mainly within behavioural high-risk groups, such as in men who have sex with men. Therefore, a vaccination programme has targeted these high-risk groups. This study evaluates the impact of the vaccination programme targeting Amsterdam's large population of men who have sex with men from 1998 through 2011.
  
  
  METHODS
  We used Amsterdam data from the national database of the vaccination programme for high-risk groups (January 1, 1998 to December 31, 2011). Programme and vaccination coverage were estimated with population statistics. Incidence of acute hepatitis B was analyzed with notification data from the Amsterdam Public Health Service (1992-2011). Mathematical modelling accounting for vaccination data and trends in sexual risk behaviour was used to explore the impact of the programme.
  
  
  RESULTS
  At the end of 2011, programme coverage was estimated at 41% and vaccination coverage from 30% to 38%. Most participants (67%) were recruited from the outpatient department for sexually transmitted infections and outreach locations such as saunas and gay bars. Incidence of acute hepatitis B dropped sharply after 2005. The mathematical model in which those who engage most in high-risk sex are vaccinated, best explained the decline in incidence.
  
  
  CONCLUSIONS
  Transmission of hepatitis B virus among Amsterdam's men who have sex with men has decreased, despite ongoing high-risk sexual behaviour. Vaccination programmes targeting men who have sex with men do not require full coverage; they may be effective when those who engage most in high-risk sex are reached.
authors: Public Health Service Amsterdam, Department of Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands. Electronic address: gvrijckevorsel@ggd.amsterdam.nl.
authors: Gini
authors: G
authors: van Rijckevorsel
authors: Jane
authors: J
authors: Whelan
authors: Mirjam
authors: M
authors: Kretzschmar
authors: Evelien
authors: E
authors: Siedenburg
authors: Gerard
authors: G
authors: Sonder
authors: Ronald
authors: R
authors: Geskus
authors: Roel
authors: R
authors: Coutinho
authors: Anneke
authors: A
authors: van den Hoek
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D018451:Homosexuality, Male; D006801:Humans; D017589:Immunization Programs; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009426:Netherlands; D014611:Vaccination
chemical_list: D017325:Hepatitis B Vaccines
keywords: 95% CI; 95% confidence interval; APC; HBV; HbsAg; Hepatitis B; IQR; MSM; Men who have sex with men; PHS; Prevention; Public Health Service; RR; Risk group; STI-OPD; UAI; Vaccination programme; age-period-cohort; anti-HBc; antibodies against hepatitis B core antigen; hepatitis B surface antigen; hepatitis B virus; incidence rate ratios; interquartile range; men who have sex with men; outpatient department for sexually transmitted infections; unprotected anal intercourse