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Abstract
A decline in the incidence of notified hepatitis B cases has been observed in major parts of Europe since the mid-1980s. Sweden may be taken as an example of a low prevalence area in the north where notifications of acute hepatitis B declined from 6 cases/100,000 inhabitants in 1985 to only 3/100,000 annually in 1988–91.
Choosing W. Germany as an example from central Europe, the notification rate of acute hepatitis B declined from 11 cases/100,000 inhabitants in 1984 to 6–8/100,000 in 1988–91. In Italy, a dramatic decline in hepatitis B infections has occurred since 1985, according to the national hepatitis surveillance system (SEIEVA), from 12 cases/100,000 inhabitants in 1985 to 5/100,000 in 1988–91. A similar trend has also been observed in the USA which seems to be unrelated to vaccination, since only limited vaccination programs have been initiated in high-risk groups. Also in Europe, changed sexual and needle-usage practices in risk groups such as drug addicts and male homosexuals have probably contributed to the observed decline. In southern Europe, rapidly improving socio-economic conditions and improved medical precautions against hepatitis B have probably also been important factors.