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Hepatitis B vaccination of men who have sex with men in the Netherlands: should we vaccinate more men, younger men or high-risk men?
  1. Maria Xiridou1,
  2. Robin van Houdt2,
  3. Susan Hahné1,
  4. Roel Coutinho1,3,
  5. Jim van Steenbergen1,
  6. Mirjam Kretzschmar1,3
  1. 1Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
  2. 2Department of Infectious Diseases, Amsterdam Municipal Health Service, Amsterdam, The Netherlands
  3. 3Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Maria Xiridou, National Institute of Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; maria.xiridou{at}rivm.nl

Abstract

Objectives The selective vaccination programme against hepatitis B virus (HBV) was introduced in the Netherlands in 2002 targeting high-risk groups, including men who have sex with men (MSM). Despite the high average age of vaccination in MSM, the number of notifications of acute HBV recently declined. We investigate whether this can be attributed to the selective vaccination programme. We examine how vaccination strategies could be improved and the impact of universal infant vaccination introduced in 2011.

Methods We use a mathematical model for HBV transmission among MSM. The incidence of HBV was calculated from the model and from notification data of acute HBV.

Results A decline was observed in the incidence of HBV since 2006, as calculated from the model; this decline was smaller than that observed in data if all MSM were equally likely to be vaccinated. Assuming that high-risk MSM were more likely to be vaccinated than low-risk MSM resulted in a steeper decline in modelled incidence and better agreement with observed incidence. Vaccinating MSM at a younger age or doubling the vaccination rate would increase the impact of selective vaccination, but is less effective than vaccinating high-risk MSM.

Conclusions Selective HBV vaccination of MSM in the Netherlands has had a substantial impact in reducing HBV incidence. The reduction suggests that vaccination rates among high-risk MSM were higher than those among low-risk MSM. Countries that have not yet reached 35-year cohorts with universal childhood vaccination should actively implement or continue selective high-risk MSM vaccination.

  • Hepatitis B
  • Vaccination
  • Mathematical Model
  • Men

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