Frontiers in public health · 2026
Population immunity to hepatitis B virus and infection marker seroprevalence in Belgrade, Serbia.
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Popova Anna Yu, Olkhovskaya Alesia Yu, Dragačević Luka, Petrova Olga A, Ostankova Yulia V, Egorova Svetlana A, Schemelev Alexandr N, Petrušić Marija, Anufrieva Ekaterina V, Ivanova Anastasiya R, Drozd Irina V, Zhimbaeva Ojuna B, Tepavcevic Darija K, Protić Jelena, Danilova Ekaterina M, Milichkina Angelica M, Ivanov Valeri A, Kotsar Oleg V, Ramsay Edward S, Smolensky Vyacheslav Y, Totolian Areg A
Аннотация
UNLABELLED: Despite global progress in hepatitis B (HB) control, assessing herd immunity and the hidden burden of infection remains critical.
AIM: This study aimed to comprehensively evaluate immunity to hepatitis B virus and HB marker prevalence in the Belgradian population (Serbia) based on infection/vaccination status and socio-demographic characteristics.
MATERIALS AND METHODS: A cross-sectional study was conducted in Belgrade in May 2024, involving 2,533 individuals. Serological markers (HBsAg, anti-HBc, anti-HBs) were evaluated using ELISA. Statistical analysis included the calculation of 95% confidence intervals, the χ2 test, and Spearman's correlation analysis.
RESULTS: The overall HBsAg prevalence was 1.0% (25/2,533), classifying Serbia as a low-endemicity region. The seroprevalence of anti-HBc and anti-HBs was 8.7% (220/2,533) and 21.6% (547/2,533), respectively. A clear age-dependent trend was observed. Markers of infection (HBsAg, anti-HBc) increased significantly with age (rs = 0.823 and rs = 0.898, respectively) among adults, peaking in the 70+ years group for anti-HBc (22.2%, 42/189). In contrast, protective anti-HBs antibodies showed a negative correlation with age (rs = -0.75), being most prevalent in children and young adults (76.9%, 10/13, in the group 1-5 years). Vaccination coverage also showed a strong negative correlation with age (rs = -0.95), declining from 82.3% (93/113) among individuals under 18 to 4.6% (16/345) among retirees. These correlations clearly illustrate differing epidemiological profiles. They range from high natural viral circulation among older, unvaccinated cohorts to effective infection control through vaccine-induced immunity in the younger generation. A low level of population awareness was identified: only 1.1% (28/2,533) of respondents reported a history of HBV, whereas serological data indicated that 8.7% (220/2,533) of the population had markers of viral exposure.
CONCLUSION: The study confirms the success of the universal child vaccination program in Serbia, which has led to the formation of a protected younger generation. However, a significant susceptible stratum persists among the adult population, alongside a high rate of undiagnosed infections, particularly in the older adults. These findings underscore the necessity of implementing targeted adult screening programs and optimizing vaccination strategies to achieve HB elimination.
AIM: This study aimed to comprehensively evaluate immunity to hepatitis B virus and HB marker prevalence in the Belgradian population (Serbia) based on infection/vaccination status and socio-demographic characteristics.
MATERIALS AND METHODS: A cross-sectional study was conducted in Belgrade in May 2024, involving 2,533 individuals. Serological markers (HBsAg, anti-HBc, anti-HBs) were evaluated using ELISA. Statistical analysis included the calculation of 95% confidence intervals, the χ2 test, and Spearman's correlation analysis.
RESULTS: The overall HBsAg prevalence was 1.0% (25/2,533), classifying Serbia as a low-endemicity region. The seroprevalence of anti-HBc and anti-HBs was 8.7% (220/2,533) and 21.6% (547/2,533), respectively. A clear age-dependent trend was observed. Markers of infection (HBsAg, anti-HBc) increased significantly with age (rs = 0.823 and rs = 0.898, respectively) among adults, peaking in the 70+ years group for anti-HBc (22.2%, 42/189). In contrast, protective anti-HBs antibodies showed a negative correlation with age (rs = -0.75), being most prevalent in children and young adults (76.9%, 10/13, in the group 1-5 years). Vaccination coverage also showed a strong negative correlation with age (rs = -0.95), declining from 82.3% (93/113) among individuals under 18 to 4.6% (16/345) among retirees. These correlations clearly illustrate differing epidemiological profiles. They range from high natural viral circulation among older, unvaccinated cohorts to effective infection control through vaccine-induced immunity in the younger generation. A low level of population awareness was identified: only 1.1% (28/2,533) of respondents reported a history of HBV, whereas serological data indicated that 8.7% (220/2,533) of the population had markers of viral exposure.
CONCLUSION: The study confirms the success of the universal child vaccination program in Serbia, which has led to the formation of a protected younger generation. However, a significant susceptible stratum persists among the adult population, alongside a high rate of undiagnosed infections, particularly in the older adults. These findings underscore the necessity of implementing targeted adult screening programs and optimizing vaccination strategies to achieve HB elimination.