Key words: hepatitis B, hepatitis B vaccination, public health

"Optimizing hepatitis B prevention and control"

This thesis aims to provide insights on the knowledge gaps existing in prevention of hepatitis B through vaccination and case finding by means of active hepatitis B virus testing in the Netherlands. Recommendations to improve vaccination practice for persons who are not protected against hepatitis B after a first series of vaccinations are: the vaccines of choice are a vaccine with a higher antigen dose or an adjuvanted vaccine and the differentiated baseline anti-HBs titre should be used to determine the number of revaccinations. To facilitate HBV case finding in the Netherlands, sexual health centres should be seen as an important health setting to detect chronic hepatitis B (CHB) patients, as sexual health centres in the Netherlands contributed approximately for 1 out of every 10 notified chronic HBV patients. As migrant groups are the largest contributor of CHB in the Netherlands and screening for HBV is cost-effective for first-generation migrants, a pro-active approach in case finding towards this group should be developed. The results of the studies included in this thesis can be used to optimize prevention and control strategies for hepatitis B.

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