Long-Term Epidemiology of Hepatitis B and Impact of Vaccination in the Autonomous Province of Vojvodina, Serbia: A Population-Based Study

This retrospective population-based study aimed to update the epidemiology of hepatitis B in Vojvodina, Serbia, and assess the impact of vaccination on acute and chronic forms of the disease. Surveillance data from 1978 to 2024 were analyzed by period, age/sex, and geographic distribution. Joinpoint and Poisson regression analyses were used to evaluate long-term trends in hepatitis B incidence and mortality rates and the vaccine-coverage effects, respectively. A decreasing trend in both acute and chronic hepatitis B incidence and mortality was observed over the study period. The average incidence rate declined from 11.51/100,000 in the pre-immunization period (1978-1987) to 1.68/100,000 during the universal immunization period (2006-2024). For chronic hepatitis B, the average incidence rates were 2.27 and 2.62/100,000 in the periods 1997-2005 and 2006-2024, respectively. Uneven spatial distribution was noted across municipalities. Poisson regression analysis showed that for every 1% increase in infant vaccine coverage in the previous year, the incidence rates of acute and chronic hepatitis B decreased significantly by 2.20% and 1.80%, respectively. These findings support the sustained effectiveness of hepatitis B vaccination, particularly among children and adolescents, and underscore the importance of addressing subnational disparities.