Declining prevalence of hepatitis B virus infection in Catalonia (Spain) 12 years after the introduction of universal vaccination

doi:10.1016/j.vaccine.2007.10.027

Vaccine

Volume 25, Issue 52, 17 December 2007, Pages 8726-8731

https://doi.org/10.1016/j.vaccine.2007.10.027 Get rights and content

Abstract

Aims

To analyze the prevalence of hepatitis B virus infection markers and hepatitis B vaccination in a representative sample of the juvenile and adult population of Catalonia and to evaluate the changes with respect to seroepidemiological surveys carried out in 1989 and 1996.

Design

In all subjects anti-HBc and anti-HBs antibodies and HBsAg were determined using an ELISA test. The possible association between sociodemographic variables and the prevalence of markers was analysed by calculating the adjusted odd ratio (simple logistic regression).

Setting

The study was carried out in 2002 in representative samples of the juvenile (5–14 years) and adult population (≥15 years) of Catalonia (Spain).

Main results

In 2002 the global prevalence of HBsAg+ was 0.7% (95% CI: 0.4–1.0) and that of anti-HBc+ 8.7% (95% CI: 7.6–9.8), values higher than those obtained in 1989 of 1.5% (95% CI: 1.0–2.1) and 15.6 (95% CI: 13.9–17.3). The prevalence of markers of infection increased with age. The only sociodemographic variable significantly associated with the prevalence of hepatitis B virus infection was the place of birth. The risk of infection was twice as high in subjects born outside Catalonia (p < 0.01), adjusted OR 2.0 (95% CI: 1.34–2.98) compared with those born in Catalonia.

Conclusions

The results of this study show that the prevalence of hepatitis B virus infection (anti-HBc+) in Catalonia (Spain) is currently the lowest it has ever been and suggest that there has been a change in the pattern of endemicity of hepatitis B virus infection in Catalonia, which has become a country of low endemicity.

Introduction

In the prevaccination era at the beginning of the 1980s, the prevalence of chronic adult HBsAg carriers in Catalonia was 1.5–2%, the estimated annual incidence of clinical cases of hepatitis B was 20–30 per 100,000 and the prevalence of markers of hepatitis B virus infection in adults was around 20%, an intermediate seroepidemiological pattern similar to that of other Mediterranean countries such as Greece and Italy, but approaching the low-endemicity pattern seen in more developed countries [1], [2], [3], [4], [5], [6].

Hepatitis B vaccination programmes began in Catalonia in 1984 with a vaccine obtained from human plasma, which was expensive and had limited availability. Vaccination was carried out in risk groups and newborns of HBsAg+ mothers, in accordance with the recommendations in place at that time. Unfortunately, as in other countries, this strategy had a limited impact on the incidence and long-term consequences of the disease, and highlighted the need for a strategy of universal vaccination in order to successfully prevent the disease. The availability of effective, safe and cheaper vaccines obtained by genetic recombination opened the way for mass vaccination programmes to protect the whole population [7].

In December 1990, the Department of Health and Social Security of the Generalitat of Catalonia, after analyzing the available data on the impact obtained (in terms of vaccination coverage and reduction of disease incidence) with the then current vaccination programmes, decided to adopt a strategy of universal vaccination of preadolescents in schools, without abandoning the vaccination of newborns of HBsAg positive mothers and high-risk groups [7].

The objective of this study was to analyze the prevalence of hepatitis B virus infection markers and hepatitis B vaccination in a representative sample of the juvenile and adult population of Catalonia and to determine the sociodemographic variables associated with the prevalence in adults.

Section snippets

Materials and methods

The study was carried out in 2002 in a representative sample of the juvenile (5–14 years) and adult population (≥15 years) of Catalonia, an autonomous region in the northeast of Spain with an estimated population in 2002 of 6.5 million.

Results

A total of 2620 people participated in the study, representing 83% (87.8% for people <15 years of age and 77.4% for those >15 years of age) of the estimated sample size.

Table 1 shows that there were no statistically significant differences between participants and the 2002 population of Catalonia [9] with respect to sex, habitat and social class but that there were differences with respect to age and place of birth.

The global prevalence of HBsAg+ was 0.7% (95% CI: 0.4–1.0) and that of anti-HBc+

Discussion

The results of this study show that the prevalence of hepatitis B virus infection (anti-HBc+) in Catalonia (Spain) is currently the lowest it has ever been [2], [4], [10]. The prevalence for all study subjects was 8.7% compared with 17.1% (some positive marker) 13 years previously [4]. Although the 1989 survey did not determine levels of anti-HBc antibodies, the prevalence of vaccinated subjects was very low at that time, since universal vaccination had still not commenced and the vaccination

Acknowledgements

We would like to thank the participating schools, the doctors, nurses and administrative staff of the primary health care centres who collaborated in obtaining clinical samples and the hospital laboratories who stored the samples.

The study was partly funded by grants from the Instituto de Salud Carlos III, Madrid (Project FIS n. 052366 and CIBER on Epidemiology and Public Health).

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Declining prevalence of hepatitis B virus infection in Catalonia (Spain) 12 years after the introduction of universal vaccination

Abstract

Aims

Design

Setting

Main results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Gastroenterol Hepatol

Vaccine

Vaccine

Vaccine

Epidemiology of acute hepatitis B

Gastroenterol Hepatol

Serologic markers for Hepatitis B virus in a group of healthy individuals

Med Clin (Barc)

The epidemiology of hepatitis B in Spain

Med Clin (Barc)

Prevalence of hepatitis B markers in the population of Catalonia (Spain). Rationale for universal vaccination of adolescents

Eur J Epidemiol

Vaccination against Hepatitis B

Vacunas

Hepatitis B vaccination stategies in Catalonia

Gastroenterol Hepatol