The impact of immigration and vaccination in reducing the incidence of hepatitis B in Catalonia (Spain)

BMC Public Health

Angela Domínguez²  Nuria Soldevila⁴  Joan Batalla³  Eva Borrás³  Gloria Carmona³  M Pilar Muñoz¹  Manuel Oviedo⁴ 

[1] Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Jordi Girona, 1-3, Barcelona, 08034, Spain;Departament de Salut Pública, Universitat de Barcelona, Casanova 143, Barcelona, 08036, Spain;Agency of Public Health of Catalonia, Roc Boronat 85, Barcelona, 08005, Spain;CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro 3-5, Barcelona, 28029, Spain

关键词: GAM model;    GLM model;    Immigration;    Vaccination;    Incidence;    Hepatitis B;   

Others  :  1163357
DOI  :  10.1186/1471-2458-12-614

 received in 2011-09-06, accepted in 2012-07-12,  发布年份 2012

【 摘 要 】

Background

The Hepatitis B virus (HBV) infection is a major cause of liver disease and liver cancer worldwide according to the World Health Organization. Following acute HBV infection, 1-5% of infected healthy adults and up to 90% of infected infants become chronic carriers and have an increased risk of cirrhosis and primary hepatocellular carcinoma. The aim of this study was to investigate the relationship between the reduction in acute hepatitis B incidence and the universal vaccination programme in preadolescents in Catalonia (Spain), taking population changes into account, and to construct a model to forecast the future incidence of cases that permits the best preventive strategy to be adopted.

Methods

Reported acute hepatitis B incidence in Catalonia according to age, gender, vaccination coverage, percentage of immigrants and the year of report of cases was analysed. A statistical analysis was made using three models: generalized linear models (GLM) with Poisson or negative binomial distribution and a generalized additive model (GAM).

Results

The higher the vaccination coverage, the lower the reported incidence of hepatitis B (p <0.01). In groups with vaccination coverage > 70%, the reduction in incidence was 2-fold higher than in groups with a coverage <70% (p <0.01). The increase in incidence was significantly-higher in groups with a high percentage of immigrants and more than 15% (p <0.01) in immigrant males of working age (19-49 years).

Conclusions

The results of the adjusted models in this study confirm that the global incidence of hepatitis B has declined in Catalonia after the introduction of the universal preadolescent vaccination programme, but the incidence increased in male immigrants of working age. Given the potential severity of hepatitis B for the health of individuals and for the community, universal vaccination programmes should continue and programmes in risk groups, especially immigrants, should be strengthened.

【 授权许可】

   
2012 Oviedo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Mackie CO, Buxton JA, Tadwalkar S, Patrick DM: Hepatitis B immunization strategies: timing is everything. Can Med J A 2009, 20:196-202.
• [2]Zanetti A, Van Damme P, Shouval D: The global impact of vaccination against hepatitis B: A historical overview. Vaccine 2008, 26:6266-6273.
• [3]Piorkowsky NY: Europe’s hepatitis challenge: defusing the “viral bomb”. J Hepatol 2009, 5:1068-1073.
• [4]Levy AR, Kowdley KV, lloeje U, Taffese E, Mukherjee J, Gish R, Bzowej N, Briggs AH: The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value in Health 2008, 11:527-538.
• [5]Beutels P: Economic evaluations of hepatitis B immunization: a global review of recent studies (1994–2000). Heal Econ 2001, 10:751-774.
• [6]Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel M, Ward JW: Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR 2008, 57(RR08):1-20.
• [7]World Health Organization: Viral hepatitis. Report by the Secretariat. Executive Board. Geneva: WHO; 2009.
• [8]Salleras L, Bruguera JM, Vidal J, Taberner JL, Plans P, Bayas JM, Pumarola T, Jimenez de Anta MT, Rodés J: Prevalence of hepatitis B markers in the population of Catalonia (Spain) Rationale for universal vaccination of adolescents. Eur J Epidemiol 1992, 8(5):640-644.
• [9]Lopalco PL, Salleras L, Barbuti S, Germinario C, Bruguera M, Buti M, Domínguez A: Hepatitis A and B in children and adolescents – what can we learn from Puglia (Italy) and Catalonia (Spain). Vaccine 2000, 19(4-5):470--474.
• [10]Salleras L, Dominguez A, Bruguera M, Cardeñosa N, Batalla J, Carmona G, Navas E, Taberner JL: Dramatic decline in acute hepatitis B infection and disease incidence rates among adolescents and young people after 12 years of a mass hepatitis B vaccination programme of pre-adolescents in the schools of Catalonia (Spain). Vaccine 2005, 23:2181-2184.
• [11]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, 34:1329-1339.
• [12]La Torre G, Nicolotti N, de Waure C, Chiaradia G, Specchia ML, Mannocci A, Ricciardi W: An assessment of the effect of hepatitis B vaccine in decreasing the amount of hepatitis B disease in Italy. Virol J 2008, 5:84. BioMed Central Full Text
• [13]Armstrong GL, Mast E, Wojczynski M, Margolis H: Childhood Hepatitis B Virus Infections in the United States Before Hepatitis B Immunization. Pediatrics 2001, 108:1123-1128.
• [14]Thornley S, Bullen C, Roberts M: Hepatitis B in a high prevalence New Zealand population: a mathematical model applied to infection control policy. J Theor Biol 2008, 254(3):599-603.
• [15]Institut d’Estadística de Catalunya (IDESCAT): Informació territorial: Banc d’estadístiques de municipis i comarques. Idescat. 2007. http://www.idescat.net/cat/poblacio/poblestructura.html webcite
• [16]Hastie TJ, Pregibon D: Generalized linear models. In Chapter 6 of Statistical Models in S. Edited by Chambers JM, Hastie TJ. Boca Raton, FL: Chapman&Hall/CRC; 1992:195-248.
• [17]Venables WN, Ripley BD: Modern Applied Statistics with S. New York: Springer; 2002.
• [18]Hastie TJ, Tibshirani RJ: Generalized additive models. New York: Chapman and Hill; 1990.
• [19]Oviedo M, Muñoz MP, Domínguez A, Borras E, Carmona G: A statistical model to estimate the impact of a hepatitis A vaccination programme. Vaccine 2008, 26:6157-6164.
• [20]Williamson JM, Lin HM, Lyles RH, Hightower AW: Power Calculations for ZIP and ZIPNB. J Data Sci 2007, 5:519-534.
• [21]Kim WR: Epidemiology of hepatitis B in the United States. Hepatology 2009, 49:S28-S34.
• [22]Centers for Disease Control and Prevention (CDC): Viral Hepatitis Surveillance – United States. 2009. http://www.cdc.gov/hepatitis/statistics/2009surveillance/ webcite
• [23]Raptopoulou M, Papatheodoridis G, Antoniou A, Ketikoglou J, Tzourmakliotis D, Vastiladis T, Manolaki N, Nikolopoulou G, Manesis E, Pierroutsakos I: Epidemiology, course and disease burden of chronic hepatitis B virus infection. HEPNET study for chronic hepatitis B: a multicentre Greek study. J Viral Hepat 2009, 16:195-202.
• [24]Buti M, Homs M, Rodriguez-Frias , Funalleras G, Jardí R, Sauleda S, Tabernero D, Schaper M, Esteban R: Clinical outcome of acute and chronic hepatitis delta over time: a long-term follow-up study. J Viral Hepat 2011, 18:434-442.
• [25]Federal Ministry of the Interior: Migration and Integration. Residence law and policy on migration and integration in Germany. ( http://www.zuwanderung.de/EN/VeroeffDokumente/veroeffdokumente_node.html webcite)
• [26]Mast EE, Weunbaum EE, Fiore AE, Alter MJ, Bell BP, Finelly L, Rodewald LE, Douglas JM, Jansen RS, Ward JW: A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. MMWR 2006, 55(RR16):1-25.
• [27]Centers for Disease Control and Prevention: Recommended adult immunization schedule- United States, 2010. MMWR 2010, 59:1-4.
• [28]American Academy of Pediatrics: 2009 Report of the Committee on Infectious Diseases. 28th edition. Edited by Elk Grove. Village, IL: American Academy of Pediatrics; 2009:337-356.
• [29]Census Bureau Homepage. 2010. http://www.census.gov webcite
• [30]Baldo V, Floreani A, Menegon T, Grella P, Paternoster DM, Trivello R: Hepatitis C virus, hepatitis B virus and human immunodeficiency virus infection in pregnant women in North-East Italy: A seroepidemiological study. Eur J Epidemiol 2000, 16:87-91.
• [31]Perz JF, Elm JL, Fiore AE, Huggler JI, Kuhnert WL, Effler PV: Near elimination of hepatitis B virus infections among Hawaii elementary school children after universal infant hepatitis B vaccination. Pediatrics 2006, 118:1403-1408.
• [32]Kretzschmar M, Mangen MJ, van de Laar M, de Wit A: Model based analysis of hepatitis B vaccination strategies in the Netherlands. Vaccine 2009, 27:1254-1260.
• [33]Oviedo M, Muñoz MP, Domínguez A, Carmona G, Batalla J, Borras E, Jansa JM: Evaluation of mass vaccination programmes: the experience of hepatitis A in Catalonia. Rev Esp Salud Pública 2009, 83:697-709.
• [34]Paerce J, Dorling D: Geographical inequalities in health in New Zealand, 1980–2001. Int J Epidemiol 2006, 35:597-603.