Surveillance and outbreak report Open Access
Like 0


Hepatitis B prevention in European Union/European Economic Area (EU/EEA) countries relies on vaccination programmes. We describe the epidemiology of acute hepatitis B virus (HBV) at country and EU/EEA level during 2006–2014. Using a multi-level mixed-effects Poisson regression model we assessed differences in the acute HBV infection notification rates between groups of countries that started universal HBV vaccination before/in vs after 1995; implemented or not a catch-up strategy; reached a vaccine coverage ≥ 95% vs < 95% and had a hepatitis B surface antigen prevalence ≥ 1% vs < 1%. Joinpoint regression analysis was used to assess trends by groups of countries, and additional Poisson regression models to evaluate the association between three-dose HBV vaccine coverage and acute HBV infection notification rates at country and EU/EEA level. The EU/EEA acute HBV infection notification rate decreased from 1.6 per 100,000 population in 2006 to 0.7 in 2014. No differences (p > 0.05) were found in the acute HBV infection notification rates between groups of countries, while as vaccine coverage increased, such rates decreased (p < 0.01). Countries with universal HBV vaccination before 1995, a catch-up strategy, and a vaccine coverage ≥ 95% had significant decreasing trends (p < 0.01). Ending HBV transmission in Europe by 2030 will require high vaccine coverage delivered through universal programmes, supported, where appropriate, by catch-up vaccination campaigns.


Article metrics loading...

Loading full text...

Full text loading...



  1. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004;11(2):97-107.  https://doi.org/10.1046/j.1365-2893.2003.00487.x  PMID: 14996343 
  2. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55.  https://doi.org/10.1016/S0140-6736(15)61412-X  PMID: 26231459 
  3. World Health Organization (WHO). Immunization coverage. Fact sheet. Updated September 2016. Geneva: WHO. Available from: http://www.who.int/mediacentre/factsheets/fs378/en/
  4. Goldstein ST, Zhou F, Hadler SC, Bell BP, Mast EE, Margolis HS. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Int J Epidemiol. 2005;34(6):1329-39.  https://doi.org/10.1093/ije/dyi206  PMID: 16249217 
  5. Duffell EF, van de Laar MJ, Amato-Gauci AJ. Enhanced surveillance of hepatitis B in the EU, 2006-2012. J Viral Hepat. 2015;22(7):581-9.  https://doi.org/10.1111/jvh.12364  PMID: 25417854 
  6. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report 2016 – Hepatitis B. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/healthtopics/hepatitisb/Pages/Annualepidemiologicalreport2016.aspx
  7. Duffell EF, van de Laar MJ. Survey of surveillance systems and select prevention activities for hepatitis B and C, European Union/European Economic Area, 2009. Euro Surveill. 2015;20(13):17-24.  https://doi.org/10.2807/1560-7917.ES2015.20.13.21080  PMID: 25860392 
  8. WHO Publication. Hepatitis B vaccines: WHO position paper--recommendations. Vaccine. 2010;28(3):589-90.  https://doi.org/10.1016/j.vaccine.2009.10.110  PMID: 19896455 
  9. World Health Organization (WHO). Global Health Sector Strategies for HIV, viral hepatitis, STIs, 2016-2021. Geneva: WHO. Available from: http://www.who.int/hiv/strategy2016-2021/en/
  10. Lernout T, Hendrickx G, Vorsters A, Mosina L, Emiroglu N, Van Damme P. A cohesive European policy for hepatitis B vaccination, are we there yet? Clin Microbiol Infect. 2014;20(Suppl 5):19-24.  https://doi.org/10.1111/1469-0691.12535  PMID: 24829936 
  11. La Torre G, Nicolotti N, de Waure C, Chiaradia G, Specchia ML, Mannocci A, et al. An assessment of the effect of hepatitis B vaccine in decreasing the amount of hepatitis B disease in Italy. Virol J. 2008;5(24):84.  https://doi.org/10.1186/1743-422X-5-84  PMID: 18652653 
  12. Pitigoi D, Rafila A, Pistol A, Arama V, Molagic V, Streinu-Cercel A. Trends in hepatitis B incidence in Romania, 1989-2005. Euro Surveill. 2008;13(2):8012.  https://doi.org/https://10.2807/ese.13.02.08012-en  PMID: 18445385 
  13. Hens N, Aerts M, Shkedy Z, Kung’u Kimani P, Kojouhorova M, van Damme P, et al. Estimating the impact of vaccination using age-time-dependent incidence rates of hepatitis B. Epidemiol Infect. 2008;136(3):341-51.  https://doi.org/10.1017/S0950268807008692  PMID: 17506920 
  14. Zanetti AR, Van Damme P, Shouval D. The global impact of vaccination against hepatitis B: a historical overview. Vaccine. 2008;26(49):6266-73.  https://doi.org/10.1016/j.vaccine.2008.09.056  PMID: 18848855 
  15. EUROSTAT website. Population and social conditions. European Commission. Available from: http://epp.eurostat.ec.europa.eu/portal/page?_pageid=0,1136184,0_45572595&_dad=portal&_schema=PORTAL
  16. World Health Organization (WHO). Centralized information system for infectious diseases (CISID). Geneva: WHO. Available from: http://data.euro.who.int/cisid/?TabID=308467
  17. O’Flanagan D, Cotter S, Mereckiene J. Hepatitis B vaccination in Europe 2008-2009. The Health Protection Surveillance Centre, European Centre for disease Control, VENICE II project. Available from: http://venice.cineca.org/Report_Hepatitis_B_Vaccination.pdf
  18. World Health Organization, Regional Office for Europe. (WHO/Europe). Action plan for the health sector response to viral hepatitis in the WHO European Region, September 2016. Copenhagen: WHO/Europe. Available from: http://www.euro.who.int/__data/assets/pdf_file/0017/318320/European-action-plan-HS-viral-hepatitis.pdf?ua=1
  19. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56(2):422-33.  https://doi.org/10.1002/hep.24804  PMID: 22105832 
  20. European Centre for Disease Prevention and Control (ECDC) Map Maker tool (EMMa). Stockholm: ECDC. Available from: https://emma.ecdc.europa.eu/Pages/home.aspx
  21. Altham PM. Introduction to R (orS-Plus) for generalized linear modelling. Statistical Laboratory of Cambridge University; 2012. pp.97.
  22. Dalgaard P. Rates and Poisson Regression. Introductory Statistics with R. New York: Springer; 2013. pp. 259-274.
  23. Simonsen L, Taylor RJ, Young-Xu Y, Haber M, May L, Klugman KP. Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States. MBio. 2011;2(1):e00309-10.  https://doi.org/10.1128/mBio.00309-10  PMID: 21264063 
  24. de Waure C, Miglietta A, Nedovic D, Mereu G, Ricciardi W. Reduction in Neisseria meningitidis infection in Italy after Meningococcal C Conjugate Vaccine introduction: a time trend analysis of 1994-2012 series. Hum Vaccin Immunother. 2016;2(12):467-73.  https://doi.org/10.1080/21645515.2015.1078951  PMID: 26308192 
  25. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335-51.  https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z  PMID: 10649300 
  26. Brouard C. Hepatitis B and C screening in France in 2010. The LaboHep 2010 Study. Bull Épidémiol Hebd. 2013. Available from: http://www.invs.sante.fr/fr./Publicationset-outils/BEH-Bulletin-epidemiologique-hebdomadaire/Archives/2013/BEH-n-19-2013
  27. Oviedo M, Muñoz MP, Carmona G, Borrás E, Batalla J, Soldevila N, et al. The impact of immigration and vaccination in reducing the incidence of hepatitis B in Catalonia (Spain). BMC Public Health. 2012;12(1):614.  https://doi.org/10.1186/1471-2458-12-614  PMID: 22867276 
  28. Carvalhana SC, Leitão J, Alves AC, Bourbon M, Cortez-Pinto H. Hepatitis B and C prevalence in Portugal: disparity between the general population and high-risk groups. Eur J Gastroenterol Hepatol. 2016;28(6):640-4.  https://doi.org/10.1097/MEG.0000000000000608  PMID: 26866523 
  29. Rantala M, van de Laar MJ. Surveillance and epidemiology of hepatitis B and C in Europe - a review. Euro Surveill. 2008;13(21):18880. .  https://doi.org/10.2807/ese.13.21.18880-en  PMID: 18761967 
  30. Rimšelienė G, Nilsen Ø, Kløvstad H, Blystad H, Aavitsland P. Epidemiology of acute and chronic hepatitis B virus infection in Norway, 1992-2009. BMC Infect Dis. 2011;11(1):153.  https://doi.org/10.1186/1471-2334-11-153  PMID: 21615904 
  31. The Public Health Agency of Sweden. Vaccination statistics. Swedish. Available from: https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/vaccinationsstatistik/
  32. Van Damme P. Long-term Protection After Hepatitis B Vaccine. J Infect Dis. 2016;214(1):1-3.  https://doi.org/10.1093/infdis/jiv750  PMID: 26802140 
  33. Matejuk A, Simon K. Impact of vaccination against HBV on hepatitis B incidence in Opolskie province in 2007-2011. Przegl Epidemiol. 2015;69(1):27-31, 135-8. PMID: 25862444 
  34. Jia Y, Li L, Cui F, Zhang D, Zhang G, Wang F, et al. Cost-effectiveness analysis of a hepatitis B vaccination catch-up program among children in Shandong Province, China. Hum Vaccin Immunother. 2014;10(10):2983-91.  https://doi.org/10.4161/hv.29944  PMID: 25483678 
  35. McMahon BJ, Bulkow LR, Singleton RJ, Williams J, Snowball M, Homan C, et al. Elimination of hepatocellular carcinoma and acute hepatitis B in children 25 years after a hepatitis B newborn and catch-up immunization program. Hepatology. 2011;54(3):801-7.  https://doi.org/10.1002/hep.24442  PMID: 21618565 
  36. Ay P, Torunoglu MA, Com S, Çipil Z, Mollahaliloğlu S, Erkoç Y, et al. Trends of hepatitis B notification rates in Turkey, 1990 to 2012. Euro Surveill. 2013;18(47):20636.  https://doi.org/10.2807/1560-7917.ES2013.18.47.20636  PMID: 24300883 
  37. European Commission. Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document C(2012) 5538). Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 27.09.2012:L 262/1. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:L:2012:262:FULL&from=EN
  38. Norwegian Institute of Public Health. Hepatitis B vaccine included in Childhood Immunisation Programme. December 2016. [Accessed 09 Feb 2017]. Available from: https://www.fhi.no/en/news/2016/na-innfores-hepatitt-b-vaksinen-i-barnevaksinasjonsprogrammet/
  39. European Centre for Disease Prevention and Control (ECDC). Communicable disease risks associated with the movement of refugees in Europe during the winter season – 10 November 2015, Stockholm: ECDC; 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/refugee-migrant-health-in-european-winter-rapid-risk-assessment.pdf
  40. European Centre for Disease Prevention and Control (ECDC). Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/publications/Publications/epidemiological-assessment-hepatitis-B-and-C-among-migrants-EU-EEA.pdf

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error