279b0f49937846abffb22b3855487b0c 306312.pdf a0e357e788349ac059d653986a9b3fd30dac1888 306312.pdf 0d690f2dc1cecd04159187a0cf46d24e4d03a8ace08214069b141877ed472ad5 306312.pdf Title: Impact of the Universal Implementation of Adolescent Hepatitis B Vaccination in Spain Subject: The aim of this study was to analyse the impact of the introduction of universal adolescent HBV vaccination on the incidence of acute hepatitis B virus (HBV) infections. Acute HBV cases reported to the Spanish National Epidemiological Surveillance Network between 2005 and 2021 were included. For regions starting adolescent vaccination in 1991–1993 and in 1994–1996, HBV incidence rates were compared by calculating the incidence rate ratio (IRR) and 95% confidence interval (CI). We also analysed the 2017 Spanish national seroprevalence survey data. The overall acute HBV incidence per 100,000 persons was 1.54 in 2005 and 0.64 in 2021 (p < 0.001). The incidence in 2014–2021 was lower for regions that started adolescent vaccination in 1991–1993 rather than in 1994–1996 (IRR 0.76; 95% CI 0.72–0.83; p < 0.001). In the 20–29 age group, incidence in regions that started adolescent vaccination in 1991–1993 was also lower (IRR 0.87; 95% CI 0.77–0.98; p = 0.02 in 2005–2013 and IRR 0.71; 95% CI 0.56–090; p < 0.001 in 2014–2021). Anti-HBc prevalence in the 35–39 age group was lower in the regions that started vaccination earlier, although the difference was not statistically significant (p = 0.09). Acute HBV incidence decreased more in the young adult population in regions that began adolescent vaccination earlier. Maintaining high universal vaccination coverage in the first year of life and in at-risk groups is necessary to achieve HBV elimination by 2030. Keywords: hepatitis B; vaccination strategy; impact evaluation Author: Angela Domínguez, Ana Avellón, Victoria Hernando, Núria Soldevila, Eva Borràs, Ana Martínez, Conchita Izquierdo, Núria Torner, Carles Pericas, Cristina Rius and Pere Godoy Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed May 1 10:04:59 2024 CEST ModDate: Wed May 1 10:11:55 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 732348 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- UURBZW+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 JUTCCP+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 FSFQLW+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 PWAXUE+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 CKUQXN+CMSY10 Type 1 Builtin yes yes yes 32 0 SXQPWE+VnURWPalladioL Type 1 Custom yes yes yes 37 0 NODKHA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 80 0 NODKHB+PalatinoLinotype CID TrueType Identity-H yes yes yes 83 0 NODKHC+PalatinoLinotype TrueType WinAnsi yes yes no 89 0 NODKHE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 92 0 NODLAC+PalatinoLinotype TrueType MacRoman yes yes no 95 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 102 0 NODKHA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 117 0 NODKHB+PalatinoLinotype CID TrueType Identity-H yes yes yes 120 0 NODKHC+PalatinoLinotype TrueType WinAnsi yes yes no 126 0 NODKHE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 129 0 NODLAC+PalatinoLinotype TrueType MacRoman yes yes no 132 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-01-22 02:41:41 CET RepresentationInformation: 306312.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-01-21 10:52:28 CET Size: 732348 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 351 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Results Destination: section.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Impact of the Universal Implementation of Adolescent Hepatitis B Vaccination in Spain Author: Angela Domínguez, Ana Avellón, Victoria Hernando, Núria Soldevila, Eva Borràs, Ana Martínez, Conchita Izquierdo, Núria Torner, Carles Pericas, Cristina Rius and Pere Godoy Subject: The aim of this study was to analyse the impact of the introduction of universal adolescent HBV vaccination on the incidence of acute hepatitis B virus (HBV) infections. Acute HBV cases reported to the Spanish National Epidemiological Surveillance Network between 2005 and 2021 were included. For regions starting adolescent vaccination in 1991 1993 and in 1994 1996, HBV incidence rates were compared by calculating the incidence rate ratio (IRR) and 95% confidence interval (CI). We also analysed the 2017 Spanish national seroprevalence survey data. The overall acute HBV incidence per 100,000 persons was 1.54 in 2005 and 0.64 in 2021 (p < 0.001). The incidence in 2014 2021 was lower for regions that started adolescent vaccination in 1991 1993 rather than in 1994 1996 (IRR 0.76; 95% CI 0.72 0.83; p < 0.001). In the 20 29 age group, incidence in regions that started adolescent vaccination in 1991 1993 was also lower (IRR 0.87; 95% CI 0.77 0.98; p = 0.02 in 2005 2013 and IRR 0.71; 95% CI 0.56 090; p < 0.001 in 2014 2021). Anti-HBc prevalence in the 35 39 age group was lower in the regions that started vaccination earlier, although the difference was not statistically significant (p = 0.09). Acute HBV incidence decreased more in the young adult population in regions that began adolescent vaccination earlier. Maintaining high universal vaccination coverage in the first year of life and in at-risk groups is necessary to achieve HBV elimination by 2030. Keywords: hepatitis B; vaccination strategy; impact evaluation Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed May 01 10:04:59 CEST 2024 ModDate: Wed May 01 10:11:55 CEST 2024 ID: 0x2c46f9edf91362933f858b5f3873d2be, 0x2c46f9edf91362933f858b5f3873d2be Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: CKUQXN+CMSY10 FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: CKUQXN+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: JUTCCP+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 150 FontDescriptor: FontName: JUTCCP+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: SXQPWE+VnURWPalladioL FontSubset: true FirstChar: 160 LastChar: 243 FontDescriptor: FontName: SXQPWE+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: FSFQLW+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 241 FontDescriptor: FontName: FSFQLW+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: UURBZW+VnURWPalladioL-Bold FontSubset: true FirstChar: 160 LastChar: 243 FontDescriptor: FontName: UURBZW+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: PWAXUE+URWPalladioL-Ital FontSubset: true FirstChar: 46 LastChar: 121 FontDescriptor: FontName: PWAXUE+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 126, 281, 152, 290 Annotation: Subtype: Link Rect: 34, 269, 143, 278 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 125, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 149, 87 Annotation: Subtype: Link Rect: 34, 756, 150, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 136, 660, 147, 674 Annotation: Subtype: Link Rect: 421, 660, 432, 674 Annotation: Subtype: Link Rect: 504, 660, 515, 674 Annotation: Subtype: Link Rect: 210, 648, 221, 661 Annotation: Subtype: Link Rect: 385, 648, 396, 661 Annotation: Subtype: Link Rect: 121, 635, 132, 649 Annotation: Subtype: Link Rect: 347, 126, 354, 135 ActionDest: 142 Annotation: Subtype: Link Rect: 360, 114, 367, 122 ActionDest: 142 Annotation: Subtype: Link Rect: 516, 88, 523, 97 ActionDest: 142 Annotation: Subtype: Link Rect: 549, 76, 556, 85 ActionDest: 142 Annotation: Subtype: Link Rect: 112, 17, 266, 28 Annotation: Subtype: Link Rect: 406, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 366, 87, 385 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 527, 731, 534, 740 ActionDest: 142 Annotation: Subtype: Link Rect: 530, 681, 537, 690 ActionDest: 142 Annotation: Subtype: Link Rect: 469, 655, 476, 665 ActionDest: 142 Annotation: Subtype: Link Rect: 198, 618, 205, 627 ActionDest: 142 Annotation: Subtype: Link Rect: 251, 605, 258, 614 ActionDest: 142 Annotation: Subtype: Link Rect: 271, 530, 278, 539 ActionDest: 145 Annotation: Subtype: Link Rect: 466, 492, 473, 501 ActionDest: 145 Annotation: Subtype: Link Rect: 319, 455, 331, 464 ActionDest: 145 Annotation: Subtype: Link Rect: 192, 430, 204, 439 ActionDest: 145 Annotation: Subtype: Link Rect: 205, 405, 217, 414 ActionDest: 145 Annotation: Subtype: Link Rect: 421, 392, 433, 401 ActionDest: 145 Annotation: Subtype: Link Rect: 434, 392, 446, 401 ActionDest: 145 Annotation: Subtype: Link Rect: 289, 367, 301, 376 ActionDest: 145 Annotation: Subtype: Link Rect: 247, 304, 259, 313 ActionDest: 145 Annotation: Subtype: Link Rect: 359, 279, 366, 288 ActionDest: 142 Annotation: Subtype: Link Rect: 366, 279, 378, 288 ActionDest: 145 Annotation: Subtype: Link Rect: 247, 141, 259, 150 ActionDest: 145 Annotation: Subtype: Link Rect: 262, 116, 274, 125 ActionDest: 145 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 513, 743, 525, 752 ActionDest: 145 Annotation: Subtype: Link Rect: 526, 744, 538, 752 ActionDest: 145 Annotation: Subtype: Link Rect: 390, 731, 402, 740 ActionDest: 145 Annotation: Subtype: Link Rect: 542, 567, 554, 576 ActionDest: 145 Annotation: Subtype: Link Rect: 544, 279, 556, 288 ActionDest: 145 Annotation: Subtype: Link Rect: 258, 163, 265, 175 ActionDest: 70 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 241, 484, 248, 495 ActionDest: 99 Annotation: Subtype: Link Rect: 549, 219, 556, 231 ActionDest: 107 Page: Sequence: 5 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 211, 492, 223, 501 ActionDest: 145 Annotation: Subtype: Link Rect: 223, 492, 235, 501 ActionDest: 145 Annotation: Subtype: Link Rect: 385, 480, 397, 489 ActionDest: 145 Annotation: Subtype: Link Rect: 398, 480, 410, 489 ActionDest: 145 Annotation: Subtype: Link Rect: 475, 467, 487, 476 ActionDest: 145 Annotation: Subtype: Link Rect: 488, 467, 500, 476 ActionDest: 145 Annotation: Subtype: Link Rect: 289, 442, 301, 451 ActionDest: 145 Annotation: Subtype: Link Rect: 544, 367, 556, 376 ActionDest: 145 Annotation: Subtype: Link Rect: 276, 291, 288, 300 ActionDest: 145 Annotation: Subtype: Link Rect: 503, 279, 515, 288 ActionDest: 145 Annotation: Subtype: Link Rect: 291, 229, 303, 238 ActionDest: 145 Annotation: Subtype: Link Rect: 317, 203, 329, 213 ActionDest: 145 Annotation: Subtype: Link Rect: 499, 116, 511, 125 ActionDest: 145 Annotation: Subtype: Link Rect: 355, 90, 367, 100 ActionDest: 145 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 227, 655, 239, 665 ActionDest: 145 Annotation: Subtype: Link Rect: 258, 643, 270, 652 ActionDest: 145 Annotation: Subtype: Link Rect: 426, 593, 438, 602 ActionDest: 148 Annotation: Subtype: Link Rect: 439, 593, 451, 602 ActionDest: 148 Annotation: Subtype: Link Rect: 308, 580, 320, 589 ActionDest: 148 Annotation: Subtype: Link Rect: 336, 568, 348, 577 ActionDest: 148 Annotation: Subtype: Link Rect: 223, 492, 235, 501 ActionDest: 148 Annotation: Subtype: Link Rect: 271, 404, 283, 414 ActionDest: 148 Annotation: Subtype: Link Rect: 342, 342, 349, 351 ActionDest: 142 Annotation: Subtype: Link Rect: 319, 204, 331, 213 ActionDest: 148 Annotation: Subtype: Link Rect: 360, 166, 372, 175 ActionDest: 148 Annotation: Subtype: Link Rect: 441, 166, 453, 175 ActionDest: 148 Annotation: Subtype: Link Rect: 257, 141, 264, 150 ActionDest: 142 Annotation: Subtype: Link Rect: 265, 141, 277, 150 ActionDest: 148 Annotation: Subtype: Link Rect: 280, 141, 292, 150 ActionDest: 148 Annotation: Subtype: Link Rect: 480, 116, 492, 125 ActionDest: 145 Annotation: Subtype: Link Rect: 492, 116, 504, 125 ActionDest: 148 Annotation: Subtype: Link Rect: 505, 116, 517, 125 ActionDest: 148 Annotation: Subtype: Link Rect: 517, 116, 529, 125 ActionDest: 148 Annotation: Subtype: Link Rect: 380, 91, 392, 100 ActionDest: 148 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 545, 718, 556, 727 ActionDest: 148 Annotation: Subtype: Link Rect: 199, 593, 211, 602 ActionDest: 148 Annotation: Subtype: Link Rect: 324, 593, 336, 602 ActionDest: 148 Annotation: Subtype: Link Rect: 367, 492, 379, 501 ActionDest: 148 Annotation: Subtype: Link Rect: 524, 467, 536, 476 ActionDest: 148 Annotation: Subtype: Link Rect: 318, 442, 330, 451 ActionDest: 148 Annotation: Subtype: Link Rect: 316, 417, 328, 426 ActionDest: 148 Annotation: Subtype: Link Rect: 221, 379, 233, 388 ActionDest: 148 Annotation: Subtype: Link Rect: 444, 367, 456, 376 ActionDest: 148 Annotation: Subtype: Link Rect: 465, 354, 477, 363 ActionDest: 148 Annotation: Subtype: Link Rect: 230, 254, 242, 263 ActionDest: 148 Annotation: Subtype: Link Rect: 543, 191, 555, 200 ActionDest: 148 Annotation: Subtype: Link Rect: 318, 166, 330, 175 ActionDest: 148 Annotation: Subtype: Link Rect: 332, 141, 344, 150 ActionDest: 152 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 489, 743, 501, 752 ActionDest: 145 Annotation: Subtype: Link Rect: 296, 706, 308, 715 ActionDest: 152 Annotation: Subtype: Link Rect: 505, 541, 560, 552 Annotation: Subtype: Link Rect: 165, 529, 357, 540 Annotation: Subtype: Link Rect: 482, 257, 560, 268 Annotation: Subtype: Link Rect: 56, 245, 394, 256 Annotation: Subtype: Link Rect: 291, 234, 560, 245 Annotation: Subtype: Link Rect: 99, 177, 137, 187 Annotation: Subtype: Link Rect: 143, 177, 179, 187 Annotation: Subtype: Link Rect: 448, 142, 486, 153 Annotation: Subtype: Link Rect: 492, 142, 528, 153 Annotation: Subtype: Link Rect: 519, 119, 557, 130 Annotation: Subtype: Link Rect: 59, 108, 95, 118 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 246, 730, 282, 741 Annotation: Subtype: Link Rect: 59, 707, 96, 718 Annotation: Subtype: Link Rect: 102, 707, 138, 718 Annotation: Subtype: Link Rect: 336, 684, 374, 694 Annotation: Subtype: Link Rect: 380, 684, 416, 694 Annotation: Subtype: Link Rect: 59, 661, 96, 671 Annotation: Subtype: Link Rect: 446, 649, 484, 660 Annotation: Subtype: Link Rect: 495, 626, 533, 637 Annotation: Subtype: Link Rect: 367, 614, 405, 625 Annotation: Subtype: Link Rect: 411, 614, 447, 625 Annotation: Subtype: Link Rect: 519, 591, 557, 602 Annotation: Subtype: Link Rect: 59, 581, 95, 591 Annotation: Subtype: Link Rect: 459, 568, 560, 579 Annotation: Subtype: Link Rect: 56, 557, 441, 568 Annotation: Subtype: Link Rect: 423, 545, 460, 556 Annotation: Subtype: Link Rect: 466, 545, 502, 556 Annotation: Subtype: Link Rect: 59, 512, 96, 522 Annotation: Subtype: Link Rect: 102, 512, 138, 522 Annotation: Subtype: Link Rect: 170, 454, 207, 464 Annotation: Subtype: Link Rect: 213, 454, 249, 464 Annotation: Subtype: Link Rect: 452, 442, 560, 453 Annotation: Subtype: Link Rect: 56, 430, 544, 441 Annotation: Subtype: Link Rect: 501, 407, 560, 418 Annotation: Subtype: Link Rect: 56, 396, 509, 407 Annotation: Subtype: Link Rect: 124, 361, 560, 372 Annotation: Subtype: Link Rect: 56, 350, 193, 361 Annotation: Subtype: Link Rect: 458, 338, 560, 349 Annotation: Subtype: Link Rect: 56, 327, 560, 338 Annotation: Subtype: Link Rect: 56, 315, 71, 326 Annotation: Subtype: Link Rect: 394, 269, 560, 280 Annotation: Subtype: Link Rect: 56, 258, 252, 269 Annotation: Subtype: Link Rect: 265, 235, 560, 246 Annotation: Subtype: Link Rect: 56, 223, 122, 234 Annotation: Subtype: Link Rect: 492, 200, 529, 211 Annotation: Subtype: Link Rect: 272, 178, 309, 188 Annotation: Subtype: Link Rect: 475, 154, 513, 165 Annotation: Subtype: Link Rect: 519, 154, 555, 165 Annotation: Subtype: Link Rect: 369, 131, 406, 142 Annotation: Subtype: Link Rect: 519, 120, 557, 131 Annotation: Subtype: Link Rect: 59, 109, 95, 119 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 520, 730, 557, 741 Annotation: Subtype: Link Rect: 59, 719, 95, 729 Annotation: Subtype: Link Rect: 168, 684, 205, 694 Annotation: Subtype: Link Rect: 212, 684, 248, 694 Annotation: Subtype: Link Rect: 171, 661, 208, 671 Annotation: Subtype: Link Rect: 214, 661, 250, 671 Annotation: Subtype: Link Rect: 99, 604, 137, 614 Annotation: Subtype: Link Rect: 309, 568, 347, 579 Annotation: Subtype: Link Rect: 420, 545, 457, 556 Annotation: Subtype: Link Rect: 400, 522, 437, 533 Annotation: Subtype: Link Rect: 443, 522, 479, 533 Annotation: Subtype: Link Rect: 164, 488, 202, 499 Annotation: Subtype: Link Rect: 208, 488, 244, 499 Annotation: Subtype: Link Rect: 59, 466, 96, 476 Annotation: Subtype: Link Rect: 102, 466, 138, 476 Annotation: Subtype: Link Rect: 519, 453, 557, 464 Annotation: Subtype: Link Rect: 59, 443, 95, 453 Annotation: Subtype: Link Rect: 59, 420, 96, 430 Annotation: Subtype: Link Rect: 102, 420, 138, 430 Annotation: Subtype: Link Rect: 59, 385, 96, 395 Annotation: Subtype: Link Rect: 102, 385, 138, 395 Annotation: Subtype: Link Rect: 131, 351, 168, 361 Annotation: Subtype: Link Rect: 175, 351, 211, 361 Annotation: Subtype: Link Rect: 501, 327, 539, 338 Annotation: Subtype: Link Rect: 520, 304, 557, 315 Annotation: Subtype: Link Rect: 382, 281, 420, 292 Annotation: Subtype: Link Rect: 302, 259, 339, 269 Annotation: Subtype: Link Rect: 345, 259, 381, 269 Annotation: Subtype: Link Rect: 519, 235, 557, 246 Annotation: Subtype: Link Rect: 59, 224, 95, 234 Annotation: Subtype: Link Rect: 519, 200, 557, 211 Annotation: Subtype: Link Rect: 59, 190, 95, 200 Annotation: Subtype: Link Rect: 479, 166, 516, 177 Annotation: Subtype: Link Rect: 521, 166, 557, 177 Annotation: Subtype: Link Rect: 446, 131, 484, 142 Annotation: Subtype: Link Rect: 144, 108, 504, 119 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 393, 730, 430, 741 Annotation: Subtype: Link Rect: 503, 706, 540, 718 Checksum: 22d3a5e5 Type: CRC32 Checksum: 279b0f49937846abffb22b3855487b0c Type: MD5 Checksum: a0e357e788349ac059d653986a9b3fd30dac1888 Type: SHA-1 Checksum: 0d690f2dc1cecd04159187a0cf46d24e4d03a8ace08214069b141877ed472ad5 Type: SHA-256