Secondary Prevention of Hepatitis B in the Netherlands

Abstract

People with chronic hepatitis B virus infection remain infectious to others and are at risk of serious liver disease such as liver cirrhosis or liver cancer later in life. In the Netherlands, hepatitis B is low endemic and acute infections are mainly transmitted through sexual contact. Chronic infections are found mostly in migrants born in countries where hepatitis B is relatively prevalent. Primary prevention of hepatitis B is possible through vaccination, but vaccination does not have an impact on pre-existing chronic infections. Screening for hepatitis B is a form of secondary prevention, whereby antiviral treatment can be used to prevent the occurrence of hepatitis B related liver disease. As the possibilities of antiviral therapy to prevent liver disease caused by chronic hepatitis B have greatly improved, it becomes more important to identify chronic hepatitis B patients. In this thesis, the following research questions are addressed: 1) What are the! transmission routes, sources of infection and risk factors for acute hepatitis B virus infection in the Netherlands?; 2) What is the prevalence of hepatitis B virus infection in different ethnic groups in Rotterdam?; 3) What is the added value of molecular analysis in hepatitis B source and contact tracing?; 4) What is the impact of secondary prevention of hepatitis B? We conclude that to increase access to antiviral treatment for patients with active chronic hepatitis B, the detection of chronic hepatitis B patients should be improved. To do so, a proactive approach is necessary as most patients do not have symptoms