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BACKGROUND & AIMS: 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.

Original publication




Journal article


J Hepatol

Publication Date





1177 - 1183


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, Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Hepatitis B, Hepatitis B Vaccines, Homosexuality, Male, Humans, Immunization Programs, Male, Middle Aged, Models, Theoretical, Netherlands, Vaccination