Hepatitis B virus infection in a group of heterosexuals with multiple partners in Amsterdam, The Netherlands: implications for vaccination?

The aim of the study was to assess prevalence and incidence of hepatitis B virus (HBV) infection among heterosexual men and women with multiple partners attending a sexually transmitted disease (STD) clinic and to establish risk factors of HBV infection in order to consider immunisation for those subjects. A prospective study of heterosexual men and women selected on having multiple partners and presenting to an STD clinic as new patients was carried out from October 1987 through December 1989. Follow-up continued until December 1990 at the STD clinic of the Municipal Health Service of Amsterdam. Five hundred ninety-eight men and women entered the study. More than 70% of both women and men had had commercial sexual partners in the last 5 years. Three hundred eighty-one participants were born in HBV low endemic countries, 205 came from HBV intermediate endemicity regions. The prevalence of HBV markers in both men and women from low endemic regions was 10%, and for men and women from middle endemic regions 42% and 19%, respectively. Logistic regression analysis showed that number of years involved in commercial sex was an independent risk factor in male participants from HBV low endemic regions (odds ratio [OR] 1.10 per year) and for women sexual contact with men at high risk of HBV infection (OR 2.59). In people from middle endemic regions more men than women had HBV markers, HBV-positive men were older than HBV-negatives (OR 1.05 per year), and for HBV-positive women the number of years involved in commercial sex was an independent predictor (OR 1.23 per year). No new cases of HBV infection were found in both groups (upper 95% limit of confidence 7.1 per 1,000 and 35.8 per 1,000 for the participants from low and middle endemic countries, respectively). The duration of follow-up was 419.9 person-years at risk for the group from low endemic regions and 83.7 person-years for the people from middle endemic regions. The participants must be considered to have been at continuous high risk of heterosexual transmission. The incidence of HBV was so low that we decided for the moment not to offer hepatitis B vaccination to all heterosexual men and women attending our STD clinic. (C) 1994 Wiley-Liss, Inc.