Selective risk group strategies in Europe

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Vaccinology

Background:

• Northern and western European countries have low endemicity of the hepatitis B virus (HBV).
• Vaccination strategies initially targeted high-risk groups for hepatitis B.
• These targeted strategies proved largely ineffective in controlling HBV spread within the general population.

Purpose of the Study:

• To evaluate the effectiveness of targeted hepatitis B vaccination strategies in low-endemicity European countries.
• To identify the reasons for the failure of high-risk group vaccination.
• To propose an alternative strategy for hepatitis B control.

Main Methods:

• Analysis of HBV vaccination strategies in northern and western Europe.
• Examination of vaccination uptake in high-risk groups versus the general population.
• Assessment of the proportion of hepatitis B cases occurring in individuals outside traditional high-risk categories.

Main Results:

• Targeted vaccination primarily reached medical and dental workers, with limited success in other high-risk groups.
• Less than half of all hepatitis B cases were identified within typical high-risk populations.
• A significant majority of infections, such as in Germany, occurred in individuals not targeted by high-risk strategies, often through heterosexual contact.

Conclusions:

• The high-risk group vaccination strategy for hepatitis B has largely failed in low-endemicity European settings.
• A substantial proportion of hepatitis B infections occur in the general population, not exclusively in high-risk groups.
• Implementing a universal hepatitis B vaccination strategy is crucial for population-wide control and eventual disease elimination.