{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:31:46Z","timestamp":1791919906089,"version":"4.3.4"},"reference-count":64,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Programme of Prevention, Surveillance, and Control of Transmissible Diseases (PREVICET)","award":["ESPCP43\/2024"],"award-info":[{"award-number":["ESPCP43\/2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: The main consequences of chronic hepatitis B virus (HBV) infections are cirrhosis and hepatocellular carcinoma (HCC), both associated with frequent hospitalization. The aim of this study was to analyze the impact of universal HBV vaccination in Spain on chronic HBV-related hospital discharges from 2005 to 2021. Methods: Using data from the Minimum Basic Data Set of the Spanish National Health System, we calculated the hospital discharge rate ratio (HDRR) and 95% confidence interval (CI) values for chronic HBV-related discharges between 2005 and 2021. For comparative purposes, we calculated the HDRR and 95% confidence interval (CI) values for the early (2005\u20132013) and later (2014\u20132021) periods and the vaccinated compared with unvaccinated cohorts for the 20\u201339 age group. Results: The hospital discharge rate per 1,000,000 people was 3.08 in 2005 and 4.50 in 2021 for HCC, and 4.81 in 2005 and 1.92 in 2021 for cirrhosis. Comparing the early and later periods, values were higher for HCC (HDRR 1.13; 95% CI: 1.06\u20131.20) and lower for cirrhosis (HDRR 0.56; 95% CI: 0.51\u20130.60). The rate for the 20\u201339 age group was lower for the vaccinated compared with the unvaccinated cohorts overall (HDRR 0.53; 95% CI: 0.45\u20130.62), for HCC (HDRR 0.66; 95% CI: 0.53\u20130.82), and for cirrhosis (HDRR 0.41; 95% CI: 0.33\u20130.53). Conclusions: This study describes the important impact, after 25 years, of universal HBV vaccination in Spain: cirrhosis hospital discharge rate was reduced, and the vaccinated cohorts, compared with the unvaccinated cohorts in the 20\u201339 age group, had a lower hospital discharge rate of both HCC and cirrhosis.<\/jats:p>","DOI":"10.3390\/vaccines12111254","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T10:57:20Z","timestamp":1730717840000},"page":"1254","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hepatitis B Virus-Related Cirrhosis and Hepatocellular Carcinoma Hospital Discharge Rates from 2005 to 2021 in Spain: Impact of Universal Vaccination"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0219-1907","authenticated-orcid":false,"given":"Angela","family":"Dom\u00ednguez","sequence":"first","affiliation":[{"name":"Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4425-6350","authenticated-orcid":false,"given":"Ana","family":"Avell\u00f3n","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Hepatitis Unit, National Centre of Microbiology, Instituto de Salud Carlos III, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Hernando","sequence":"additional","affiliation":[{"name":"Centro Nacional de Epidemiolog\u00eda, Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1353-5325","authenticated-orcid":false,"given":"N\u00faria","family":"Soldevila","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3859-9907","authenticated-orcid":false,"given":"Eva","family":"Borr\u00e0s","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Ag\u00e8ncia de Salut P\u00fablica de Catalunya, 08005 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Ag\u00e8ncia de Salut P\u00fablica de Catalunya, 08005 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2611-6055","authenticated-orcid":false,"given":"Conchita","family":"Izquierdo","sequence":"additional","affiliation":[{"name":"Ag\u00e8ncia de Salut P\u00fablica de Catalunya, 08005 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0143-5295","authenticated-orcid":false,"given":"N\u00faria","family":"Torner","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carles","family":"Pericas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain"},{"name":"Ag\u00e8ncia de Salut P\u00fablica de Barcelona, 08023 Barcelona, Spain"},{"name":"Institut de Recerca de l\u2019Hospital de la Santa Creu i Sant Pau (IRB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Rius","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Ag\u00e8ncia de Salut P\u00fablica de Barcelona, 08023 Barcelona, Spain"},{"name":"Institut de Recerca de l\u2019Hospital de la Santa Creu i Sant Pau (IRB Sant Pau), 08041 Barcelona, Spain"},{"name":"Department MELIS-UPF, Universitat Pompeu Fabra, 08002 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2896-7286","authenticated-orcid":false,"given":"Pere","family":"Godoy","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Institut de Recerca Biom\u00e9dica de Lleida (IRBLleida), 25006 Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0140-6736(22)01468-4","article-title":"Hepatitis B","volume":"401","author":"Jeng","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/hep.1840080310","article-title":"The development of cirrhosis in patients with chronic type hepatitis B: A prospective study","volume":"8","author":"Liaw","year":"1998","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S173","DOI":"10.1002\/hep.20956","article-title":"Natural history of chronic hepatitis B virus infection: What we knew in 1981 and what we know in 2005","volume":"43","author":"Yim","year":"2006","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.12688\/wellcomeopenres.17601.3","article-title":"Sexual dimorphism in chronic hepatitis B virus infection: Evidence to inform elimination efforts","volume":"7","author":"Brown","year":"2022","journal-title":"Wellcome Open Res."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hamilton, E., Yang, L., Mentzer, A.J., Guo, Y., Chen, Y., Lv, J., Fletcher, R., Wright, N., Lin, K., and Walters, R. (2022). Conventional and genetic risk factors for chronic Hepatitis B virus infection in a community-based study of 0.5 million Chinese adults. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-16360-7"},{"key":"ref_6","unstructured":"Orenstein, W.A., Offit, P.A., Edwards, K.M., and Plotin, S.A. (2024). Hepatitis B vaccines. Plotkin\u2019s Vaccines, Elsevier. [8th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41256-024-00345-2","article-title":"Assessing the impact of comorbid type 2 diabetes mellitus on the disease burden of chronic hepatitis B virus infection and its complications in China from 2006 to 2030: A modeling study","volume":"9","author":"Xie","year":"2024","journal-title":"Glob. Health Res. Policy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jhep.2019.08.025","article-title":"Epidemiology and surveillance for hepatocellular carcinoma: New trends","volume":"72","author":"Singal","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S2468-1253(22)00124-8","article-title":"Global, regional, and national burden of hepatitis B, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"7","author":"Sheena","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_10","unstructured":"World Health Organization (2024, April 09). Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240091672."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"8726","DOI":"10.1016\/j.vaccine.2007.10.027","article-title":"Declining prevalence of hepatitis B virus infection in Catalonia (Spain) 12 years after the introduction of universal vaccination","volume":"25","author":"Salleras","year":"2007","journal-title":"Vaccine"},{"key":"ref_12","first-page":"e202003018","article-title":"Committee for Immunization Programme and Registry and changes in the National Immunization Programme in Spain","volume":"94","author":"Limia","year":"2020","journal-title":"Rev. Esp. Salud Publica"},{"key":"ref_13","first-page":"113","article-title":"Vaccination against hepatitis B. Impact of vaccination programmes after 20 years of use in Spain. Is it time for a change?","volume":"33","year":"2015","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.vaccine.2019.01.024","article-title":"Effectiveness and impact of the hepatitis B vaccination program in preadolescents in Catalonia 21 years after its introduction","volume":"37","author":"Urbiztondo","year":"2019","journal-title":"Vaccine"},{"key":"ref_15","unstructured":"Ministerio de Sanidad (2024, March 20). Vaccination Coverage History. Spain 2000\u20132013. Available online: https:\/\/www.sanidad.gob.es\/areas\/promocionPrevencion\/vacunaciones\/coberturas\/docs\/Todas_las_tablas2013.pdf."},{"key":"ref_16","unstructured":"Ministerio de Sanidad (2024, March 20). Evolution of Primary Vaccination Coverage. Spain 2010\u20132020. Available online: https:\/\/www.sanidad.gob.es\/areas\/promocionPrevencion\/vacunaciones\/coberturas\/docs\/Todas_las_tablas2020.pdf."},{"key":"ref_17","first-page":"169","article-title":"Epidemiological surveillance of hepatitis B in Spain, 1997 to 2008","volume":"18","author":"Hernando","year":"2010","journal-title":"Bol. Epidem. Sem."},{"key":"ref_18","first-page":"43","article-title":"Analysis of the evolution of acute hepatitis B in Spain, 2008\u20132018","volume":"27","author":"Hernando","year":"2019","journal-title":"Bol. Epidem. Sem."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S343","DOI":"10.1093\/infdis\/jiaa668","article-title":"Hepatitis B Vaccines","volume":"224","author":"Pattyn","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ruggieri, A., Gagliardi, M.C., and Anticoli, S. (2018). Sex-dependent outcome of hepatitis B and C viruses infections: Synergy of sex hormones and immune responses?. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.02302"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.11604\/pamj.2021.38.99.25195","article-title":"Hepatocellular carcinoma in Senegal: Epidemiological, clinical and etiological aspects about 229 cases at H\u00f4pital Principal de Dakar","volume":"38","author":"Diallo","year":"2021","journal-title":"Pan Afr. Med. J."},{"key":"ref_22","first-page":"e16558","article-title":"Demographics, biochemical characteristics, and phases of chronic hepatitis B virus infection: Retrospective analysis from a secondary care setup","volume":"13","author":"Khan","year":"2021","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e13828","DOI":"10.7717\/peerj.13828","article-title":"Gender differences in demographic and clinical characteristics in patients with HBV-related liver diseases in China","volume":"10","author":"Liu","year":"2022","journal-title":"PeerJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1002\/jmv.24243","article-title":"Gender differences in chronic HBsAg carriers in Italy: Evidence for the independent role of male sex in severity of liver disease","volume":"87","author":"Stroffolini","year":"2015","journal-title":"J. Med. Virol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","article-title":"Hepatocellular carcinoma","volume":"7","author":"Llovet","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1111\/jgh.15340","article-title":"Massive impact of coronavirus disease 2019 pandemic on gastroenterology and hepatology departments and doctors in Spain","volume":"36","author":"Crespo","year":"2021","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"n1135","DOI":"10.1136\/bmj.n1135","article-title":"Hospital admission and mortality rates for non-covid diseases in Denmark during the Covid-19 pandemic: Nationwide population based cohort study","volume":"373","author":"Bodilsen","year":"2021","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1002\/hep.29320","article-title":"The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B","volume":"66","author":"Papatheodoridis","year":"2017","journal-title":"Hepatology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"40086","DOI":"10.57187\/smw.2023.40086","article-title":"The current and future burden of hepatitis B in Switzerland: A modelling study","volume":"153","author":"Negro","year":"2023","journal-title":"Swiss Med. Wkly."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Huang, C., Wu, Y., Zhang, C., Ji, D., and Wang, F.S. (2023). The burden of cirrhosis and other chronic liver diseases due to hepatitis B in children and adolescents: Results from global burden of disease study 2019. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1315392"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1002\/jmv.24873","article-title":"Influence of universal HBV vaccination on chronic HBV infection in Italy: Results of a cross-sectional multicenter study","volume":"89","author":"Sagnelli","year":"2017","journal-title":"J. Med. Virol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1053\/j.gastro.2016.05.048","article-title":"Long-term effects of hepatitis B immunization of infants in preventing liver cancer","volume":"151","author":"Chang","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"a021410","DOI":"10.1101\/cshperspect.a021410","article-title":"Hepatitis B virus epidemiology","volume":"5","author":"MacLachlan","year":"2015","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e2222367","DOI":"10.1001\/jamanetworkopen.2022.22367","article-title":"Association of nationwide hepatitis B vaccination and antiviral therapy programs with end-stage liver disease burden in Taiwan","volume":"5","author":"Chiang","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Qu, C., Chen, T., Fan, C., Zhan, Q., Wang, Y., Lu, J., Lu, L.L., Ni, Z., Huang, F., and Yao, H. (2014). Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study: A cluster randomized controlled trial. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001774"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1002\/hep.24442","article-title":"Elimination of hepatocellular carcinoma and acute hepatitis B in children 25 years after a hepatitis B newborn and catch-up immunization program","volume":"54","author":"McMahon","year":"2011","journal-title":"Hepatology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1111\/liv.14821","article-title":"The impact of universal hepatitis B vaccine on the trend of liver cancer from the Global Burden of Disease Study 2017","volume":"41","author":"Li","year":"2021","journal-title":"Liver Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e701","DOI":"10.1016\/S2468-2667(23)00149-4","article-title":"Hepatitis B and C in Europe: An update from the Global Burden of Disease Study 2019","volume":"8","author":"Cortesi","year":"2023","journal-title":"Lancet Public Health"},{"key":"ref_39","unstructured":"World Health Organization (2024, April 05). Combating Hepatitis B and C to Reach Elimination by 2030. Available online: https:\/\/www.who.int\/publications\/i\/item\/combating-hepatitis-b-and-c-to-reach-elimination-by-2030."},{"key":"ref_40","first-page":"2049","article-title":"Trends in mortality of liver disease due to hepatitis B in China from 1990 to 2019: Findings from the Global Burden of Disease Study","volume":"135","author":"Cao","year":"2022","journal-title":"Chin. Med. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1038\/s41575-023-00760-9","article-title":"Global burden of hepatitis B virus: Current status, missed opportunities and a call for action","volume":"20","author":"Hsu","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_42","first-page":"236","article-title":"Outcome of HBV screening and vaccination in a migrant population in southern Italy","volume":"29","author":"Mazzitelli","year":"2021","journal-title":"Infez. Med."},{"key":"ref_43","first-page":"223","article-title":"Risk factors for hepatitis B and C among healthy population: A community-based survey from four districts of Southern Italy","volume":"28","author":"Serraino","year":"2020","journal-title":"Infez. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1111\/jgh.14984","article-title":"Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals","volume":"35","author":"Buti","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1111\/jvh.13868","article-title":"Persistent low prevalence of hepatitis B vaccination among people with HIV: Time for a change?","volume":"30","author":"Vigil","year":"2023","journal-title":"J. Viral Hepat."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1111\/liv.15548","article-title":"Susceptibility to hepatitis B virus infection in adults living in Spain","volume":"43","author":"Soriano","year":"2023","journal-title":"Liver Int."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Al-Busafi, S.A., and Alwassief, A. (2024). Global perspectives on the hepatitis B vaccination: Challenges, achievement, and the road to elimination by 2030. Vaccines, 12.","DOI":"10.20944\/preprints202402.0493.v1"},{"key":"ref_48","unstructured":"European Association for the Study of the Liver (2018). EASL clinical practice guidelines: Management of hepatocellular carcinoma. J. Hepatol., 69, 182\u2013236."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Peeling, R.W., Boeras, D.I., Marinucci, F., and Easterbrook, P. (2017). The future of viral hepatitis testing: Innovations in testing technologies and approaches. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2775-0"},{"key":"ref_50","unstructured":"World Health Organization (2024, October 24). Global Hepatitis Report. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241565455."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s40249-022-01032-5","article-title":"Impact of the national hepatitis B immunization program in China: A modeling study","volume":"11","author":"Liu","year":"2022","journal-title":"Infect. Dis. Poverty"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Boccalini, S., Bonito, B., Zanella, B., Liedl, D., Bonanni, P., and Bechini, A. (2022). The first 30 years of the universal hepatitis-B vaccination-program in Italy: A health strategy with a relevant and favorable economic-profile. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192316365"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s40121-023-00795-0","article-title":"Real-world epidemiology, clinical and economic burden of chronic hepatitis B in Japan: A retrospective study using JMDC claims database","volume":"12","author":"Umemura","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1136\/jech.46.6.587","article-title":"Cost-benefit analysis of a nationwide neonatal inoculation programme against hepatitis B in an area of intermediate endemicity","volume":"46","author":"Ginsberg","year":"1992","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jhep.2020.09.013","article-title":"A global investment framework for the elimination of hepatitis B","volume":"74","author":"Howell","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_56","unstructured":"World Hepatitis Alliance (2024, May 08). The Importance of Hepatitis B and C Control and Elimination. Available online: https:\/\/www.worldhepatitisalliance.org\/wp-content\/uploads\/2018\/06\/20170906_wha_hcvhbv_advocacy_final_update_edited_web_version.pdf."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Flores, J.E., Thompson, A.J., Ryan, M., and Howell, J. (2022). The global impact of hepatitis B vaccination on hepatocellular carcinoma. Vaccines, 10.","DOI":"10.3390\/vaccines10050793"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"8199","DOI":"10.3748\/wjg.v27.i47.8199","article-title":"Progress on global hepatitis elimination targets","volume":"27","author":"Waheed","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"(2024). Viral hepatitis elimination\u2014Time to act. Nat. Rev. Gastroenterol. Hepatol., 21, 529.","DOI":"10.1038\/s41575-024-00963-8"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/S2468-1253(23)00233-9","article-title":"WHO 2030 HBV elimination goals: A goal too far?","volume":"8","author":"Lim","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S2468-1253(23)00321-7","article-title":"Progress towards elimination of viral hepatitis: A Lancet Gastroenterology & Hepatology Commission update","volume":"9","author":"Cooke","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1157\/13097663","article-title":"Documento de consenso de la AAEEH sobre el tratamiento de las infecciones por los virus de las hepatitis B y C","volume":"29","author":"Bruguera","year":"2006","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_63","first-page":"91","article-title":"Optimal control strategies for preventing hepatitis B infection and reducing chronic liver cirrhosis incidence","volume":"27","author":"Khatun","year":"2019","journal-title":"Infect. Dis. Model."},{"key":"ref_64","unstructured":"Ministerio de Sanidad (2024, July 10). Informe del SNS 2020\u20132021. Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/sisInfSanSNS\/tablasEstadisticas\/InfAnualSNS2020_21\/ASPECTOS_RELEVANTES_2020-21.pdf."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/11\/1254\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:26:15Z","timestamp":1760113575000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/11\/1254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":64,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["vaccines12111254"],"URL":"https:\/\/doi.org\/10.3390\/vaccines12111254","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,4]]}}}