Molecular sequence data of hepatitis B virus and genetic diversity after vaccination.

W Marijn van Ballegooijen, Robin van Houdt, Sylvia M Bruisten, Hein J Boot, Roel A Coutinho, Jacco Wallinga

RIVM, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. marijn.van.ballegooijen@rivm.nl

American journal of epidemiology 2009 Dec 15

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The effect of vaccination programs on transmission of infectious disease is usually assessed by monitoring programs that rely on notifications of symptomatic illness. For monitoring of infectious diseases with a high proportion of asymptomatic cases or a low reporting rate, molecular sequence data combined with modern coalescent-based techniques offer a complementary tool to assess transmission. Here, the authors investigate the added value of using viral sequence data to monitor a vaccination program that was started in 1998 and was targeted against hepatitis B virus in men who have sex with men in Amsterdam, the Netherlands. The incidence in this target group, as estimated from the notifications of acute infections with hepatitis B virus, was low; therefore, there was insufficient power to show a significant change in incidence. In contrast, the genetic diversity, as estimated from the viral sequence collected from the target group, revealed a marked decrease after vaccination was introduced. Taken together, the findings suggest that introduction of vaccination coincided with a change in the target group toward behavior with a higher risk of infection. The authors argue that molecular sequence data provide a powerful additional monitoring instrument, next to conventional case registration, for assessing the impact of vaccination.

Citation

W Marijn van Ballegooijen, Robin van Houdt, Sylvia M Bruisten, Hein J Boot, Roel A Coutinho, Jacco Wallinga. Molecular sequence data of hepatitis B virus and genetic diversity after vaccination. American journal of epidemiology. 2009 Dec 15;170(12):1455-63