Hepatitis B vaccination of men who have sex with men in the Netherlands: should we vaccinate more men, younger men, or high-risk men?

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1 Hep B vnon of en who hve ex wh en n he eheln: houl we vne oe en younge en o hgh-k en? M ou Robn vn Hou Sun Hhné Roel ounho J vn Seenbegen Mj Kezh APPEDI A.. Moel equon The oel w evelope by Kezh e l ] o ebe he non of HBV n he eheln fo he whole populon heeoexul n MSM. The uboel fo he MSM populon ebe by he followng ye of pl ffeenl equon n e n ge ] ] ] ] ] ] ] V V V w p w Z p Z Z H H v u H H v u z e e whee he ubp =... 6 enoe exul vy goup. enoe he eny of unnfee nvul H he eny of nvul wh len nfeon he eny of nvul wh ue HBV he eny of e hon HBV Z he eny of une nvul n V he eny of vne nvul of vy goup ge e. The ze of vy goup V Z H n he ol populon ze. The foe of nfeon gven by ] whee we ue popoone xng by ge n vy l.

2 Bh no he populon wee ue o blne he eh e uh h he populon ze en onn. Deh o eovl fo he populon ue o ou ge 65 uh h he ge buon ove he populon unfo. Men e ue o beoe exully ve he ge of 5. The fon of nfee nvul of ge who beoe e gven by he funon x p exp x wh x = n x = ]. The populon ze onn ung h bh no he populon blne eh n en of exul vy. Invul ene he populon n pef exul k goup n en n h goup fo lfe. The buon ove he k goup onn n e. Vne nvul e une o nfeon fo lfe. Defnon of pee n eful vlue e ebe n he followng n uze n Tble. The oel equon wee olve nuelly ung he Elo Box Tn eho pleene n he pkge EBT ool 4]. A.. Pne hnge e n oel lbon The e of foon of new pnehp fo en of ge n exul vy goup wee nlly ee fo fo he uy Sexul Helh n he eheln e ou by Ruge WPF n 006 5]. Th w populon uy wh wo phe of euen v nene pnel. Fo he f phe he eponen wee noly elee whle fo he eon phe he eponen wee elee non-noly o heve epeenve ple wh epe o he eogph of he Duh populon ge gene euon n ehny. The eponen oplee n nene-be queonne bou eogph he n exul behvou. Fo 470 eponen 76 wee egoe MSM ong o he epoe nwe. The ol nube of pne h eponen epoe o hve h n he pevou x onh w eue by one f he lo epoe hvng ey pne fo oe hn x onh n he e peo; fo hee he nube of new pne n he pevou x onh w lule. Pnehp fo whh onen ono ue w epoe wee no ken no oun. Subequenly Webull buon w fe o he by he xu lkelhoo eho fo eh of he egh ge egoe n 50+ hown n Tble. The uulve buon wee hen ubve no x nevl efne by he fon w = ee Tble A n A. Th ubvon efne he ze of he x exul vy goup fo exple goup 45.% of he populon n goup 5.% of he populon. Th ubvon by bu hoen o efle kewe buon of nube of pne n efne n 6]. The vege pne hnge e e hen lule fo eh vy goup n eh ge goup hown n Tble A.

3 Wh hee ee e he oel genee ey e nene of 6 pe Th oel ee w ope o he ee nene fo he follow. In he ye 00 o 005 when vnon w noue HBV nene w elvely ble ppoxely 05 ue HBV e ong MSM pe ye beng epoe he nonl nofon. Aung h h of he e e lnl n h hee 50% uneepong ple h he epoe nube of ue HBV e houl be ulple by fo of 6 o gve he ul nube of new HBV e. Th en h hee wee 05*6 =60 new e of HBV n MSM pe ye. The ol nube of MSM n he eheln w ee o be n he nevl expole 95% onfene nevl be on he populon uvey of Ruge WPF n 006 5]. Dvng he 60 new e by h ee of he MSM populon ze eul n n nene beween 60 n 7 new nfeon pe Theefoe fo he nene of HBV he ee fo he oel w hghe hn h fo he. Moeove opng he ge buon of nen nfeon lule fo he oel n he ge buon of he nofe e of ue HBV we fn h he foe oe hfe o younge ge. In ohe wo he fon of new nfeon oung young ge n he oel hghe hn h n he n he fon oung ol ge lowe n he oel hn h n he eul no hown. To oun fo hee nonene beween he oel n he we lbe he oel by jung he pne hnge e uh h he nene n he ge buon of nen e fo he oel woul h hoe fo he. The jue pne hnge e e hown n Tble A. Wh hee e he b epouon nube lule R 0 =.6 n he nene 90 new nfeon pe The ge buon of nen nfeon fo he oel he ey e whou vnon n he ge buon of he nofe ue HBV e n he l ye befoe he nouon of vnon: nofon e hown n Fgue A. Moeove he pevlene of HBV nfeon fo he oel lo n one wh h fo he. Aong en ge 5 60 ye ol he pevlene of une % n he pevlene of e oun % fo he oel. In he uen onl HBV Vnon pgn en who wn o be vne eeve he f vne oe n he e e ge ee fo HBV nfeon ubequenly only hoe unnfee eeve he ohe wo oe. Aong hoe peenng o be vne n 00 he f ye of he vnon pgn 6% w n- HB pove n.% w HBAg pove fo he onl HBV Vnon pgn. Howeve beleve h he en ppng n he vnon pog hve on vege hghe k level hn he genel MSM populon.

4 A.. Vnon e The vnon e epeen unvel vnon n gven by he followng funon u P whee enoe he D funon u he vne fon n P he ge of vnon pubey. The e of vnng hlen of gn gven by l funon ee ] fo el. The e of k-goup vnon wee lule follow. The ze of he MSM populon n he eheln w ue o be 0000 he pon of he nevl obne fo he populon uvey of Ruge WPF 5]. A he of he vnon pgn 85% of he e uepble fo HBV n hene elgble fo vnon. Theefoe n evey ge egoy he nube of en elgble fo vnon gven by he pou of he ol nube of MSM n he fon foun uepble ve by he nube of ge egoe: 0000*0.85/=75. Dung he even ye of he vnon pgn en eeve one oe of HBV vne 4574 eeve wo oe n 08 eeve hee oe of he vne. The nnul vnon e n ln 7* 75 pe ge egoy wee ee whee n he nube of vnon of nhb negve peon n ge egoy ung he oue of he vnon pgn ee Tble A4. Fo he eful eno w ue h h vnon e he e fo ll vy goup enng fo ll ge n ge egoy =... ee Tble A4 n ll vy goup = The effeve unzon e hen gven he pou of vnon e n vne effy v. 4

5 REFEREES. Kezh M e W G S L n vn e L M. Vnon gn hep B n low ene oune Epeol. Infe. 00 8: Kezh M Mngen M vn e L M n e W A. Moel be nly of hep B vnon ege n he eheln Vne 009 7: Eun W Meley G oke D Hll A n Whle H. The nfluene of ge on he evelopen of he hep B e e Po. R. So. Lon. B 99 5: De Roo A. A genle nouon o oel of phyologlly uue populon n S. Tuljpuk n H. well. e Suue-populon oel n ne eel n fehwe ye hp n Hll ew ok pp Ruge o Goup. Sexul helh n he eheln 006 Ebuon Delf Wll J oke D Meley G n Aneon R. The non yn of hep B n he UK: hel oel fo evlung o n effevene of unzon poge Epeol. Infe : Boo H Shoul L Hhne S Bebe G vn e L M n Kn T. Vnon gn peuoo n hep B n he Duh onl Iunzon Poge e. Tjh. Geneek : 7 6. In Duh. 5

6 Tble A: Moel pee n belne vlue Sybol Defnon Vlue Soue Pobbly of non: pe pnehp wh uely nfee n ] pe pnehp wh e 0. 6] hozonl fo houehol on ge ] Re of pogeon: 5 0 7] fo len o ue HBV ] fo ue o hon HBV.467 6] fo hon o une HBV ] p Popoon of ue e ge beong e exp ] Vnon e fo en of ge vy l Tble A4 v Vne effy fo ul vnon 0.75 Tble A5 v Vne effy fo hlen e 0.9 k Fon of hlen elgble fo k goup vnon 0.5 7] u Fon of elgble gn hlen vne 0.9 7] u Popoon of eu o exully ve populon beng vne 0.85 ] Pevlene of hon e ong gn ] z Pevlene of une peon ong gn 0. 7] Pe p gon e Fon of le ong gn 0.5 Age buon of gn ] v Fely of ge ] 6

7 Tble A: Re of foon of exul pnehp ee fo fo Ruge WPF Popoon n l w Sexul vy goup Avege Age nge Pne hnge e Tble A: Ajue e of foon of exul pnehp* Popoon n l w Sexul vy goup Avege Age nge Pne hnge e * The e fo Tble A fo Ruge WPF wee jue uh h he nene n he ge buon of nen nfeon woul h hoe fo he ee eho fo el. 7

8 Tble A4: Age-epenen nnul vnon e ong MSM n he eheln Goup Age ube wh f vnon ll ye* Dbuon Annul vnon e < Tol * D fo he onl HBV Vnon pgn The nube of vnon w jue fo he nube of MSM eevng he f vne oe o oun fo he ol nube of expee vnon ung he even ye of he pgn. Fuheoe w ue h 5% of MSM wee nhb+ n hene no elgble fo vnon. Tble A5: Vne effy: peenge beng 00% poee gn HBV nfeon ong hoe eevng one wo o hee oe of HBV vne Doe vne eeve oplne % unze fe oe % effevely unze fe oe 00% 40% 0% 75% 70% 9% 6% 90% 75% 8

9 Tble A6: Age-epenen nnul vnon e ong MSM n he eheln * Annul vnon e fo hypohel eno Age ube Only k Only k Only k goup Vne Double wh f goup 654 goup & hlf of 4 5 ye vnon vnon* vne vne vne younge < * D fo he onl HBV Vnon pgn Tble A7: Annul nube of MSM who eeve HBV vne n he eheln fo he onl HBV Vnon pgn. ube of MSM vne gn HBV e ube wh vne oe ube wh vne oe ov-de Jn-ov

10 peenge new nfeon ge ofon Moel: pe-vnon ey e Fgue A: Age buon of new hep B nfeon fo he oel n fo befoe he nouon of vnon. Geen olun: he ge buon of epoe ue hep B nfeon ong en who hve ex wh en n he eheln n he ye fo he onl ofon D. Blue olun: he ge buon of new nfeon lule fo he oel he ey e whou vnon; fo hee eul he jue pne hnge e wee ue Tble A n he pee hown n Tble A. 0