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American Journal of Epidemiology Advance Access published online on November 12, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwp375
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

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 and Jacco Wallinga

* Correspondence to Dr. W. Marijn van Ballegooijen, RIVM, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands (e-mail: marijn.van.ballegooijen{at}rivm.nl).

Received for publication December 8, 2008. Accepted for publication August 21, 2009.

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.

communicable diseases; disease notification; disease transmission, infectious; genetic variation; hepatitis B virus; molecular sequence data; vaccination

Abbreviations: HBV, hepatitis B virus; HIV, human immunodeficiency virus; MSM, men who have sex with men

Editor's note: An invited commentary on this article appears on page 000, and the authors’ response is published on page 000.


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