TABLE 1. Year of introduction of hepatitis B vaccine, hepatitis B vaccine routine vaccination and birth dose policies, vaccination schedule, coverage with a third dose of hepatitis B vaccine and a timely hepatitis B birth dose, and antenatal screening for hepatitis B virus infection — World Health Organization European Region, 2016–2019.
| Country (year of HepB introduction*,†) | HepB vaccination policy*,§ |
2019 HepB schedule* | HepB3 coverage,* % |
Timely HepB-BD coverage,* % |
Antenatal screening |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Infant/Childhood | At birth | Year |
≥90% each year, 2017–2019¶ | Year |
≥90% each year, 2017–2019¶ | In place** | Coverage, %†† | ||||||||
| 2016 | 2017 | 2018 | 2019 | 2016 | 2017 | 2018 | 2019 | ||||||||
| Albania (1994) |
Universal |
Universal |
B, 2, 4, 6 mos |
98 |
99 |
99 |
99 |
Yes |
99 |
99 |
99 |
99 |
Yes |
— |
— |
| Andorra (1997) |
Universal |
Selective |
2, 4, 12 mos |
94 |
98 |
98 |
98 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Armenia (2000) |
Universal |
Universal |
B, 6, 12, 18 wks, 18 mos |
94 |
94 |
92 |
92 |
Yes |
98 |
97 |
97 |
96 |
Yes |
— |
— |
| Austria (1997) |
Universal |
Selective |
2, 4, 10 mos |
87 |
90 |
85 |
85 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Azerbaijan (2001) |
Universal |
Universal |
B, 2, 3, 4 mos |
97 |
95 |
95 |
94 |
Yes |
99 |
99 |
99 |
98 |
Yes |
— |
— |
| Belarus (1996) |
Universal |
Universal |
B, 2, 3, 4 mos |
96 |
98 |
98 |
97 |
Yes |
98 |
98 |
98 |
98 |
Yes |
— |
— |
| Belgium (1996) |
Universal |
Selective |
8, 12, 16 wks, 15 mos |
97 |
97 |
97 |
97 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
80–85 |
| Bosnia and Herzegovina (2001) |
Universal |
Universal |
B, 1, 6 mos |
78 |
77 |
80 |
80 |
No |
NR |
NR |
NR |
NR |
NR |
— |
— |
| Bulgaria (1991) |
Universal |
Universal |
B, 1, 6 mos; B, 2, 3, 4 mos |
91 |
92 |
85 |
85 |
No |
96 |
97 |
96 |
96 |
Yes |
— |
— |
| Croatia (1999) |
Universal |
Selective |
2, 4, 6, 18 mos |
92 |
92 |
93 |
93 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
>90 |
| Cyprus (1989) |
Universal |
Selective |
2, 4, 8–12 mos |
97 |
97 |
97 |
94 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Czechia (2001) |
Universal |
Selective |
3, 5, 11 mos |
96 |
94 |
96 |
97 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
100 |
| Denmark (2009)§§ |
Selective |
Selective |
— |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
Yes |
99.9 |
| Estonia (2003) |
Universal |
Selective |
3, 4.5, 6 mos, 2 yrs |
93 |
92 |
93 |
91 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
>90 |
| Finland (1993)§§ |
Selective |
Selective |
— |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
Yes |
97.8 |
| France (1994) |
Universal |
Selective |
2, 4, 11 mos |
90 |
90 |
91 |
91 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
92.4 |
| Georgia (2001) |
Universal |
Universal |
B, 2, 3, 4 mos |
92 |
91 |
93 |
94 |
Yes |
94 |
94 |
97 |
94 |
Yes |
— |
— |
| Germany (1995) |
Universal |
Selective |
2, 3, 4, 11–14 mos |
87 |
87 |
87 |
87 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
>90 |
| Greece (2000) |
Universal |
Selective |
2, 4, 6–18 mos |
96 |
96 |
96 |
96 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
91.3 |
| Hungary (1999)¶¶ |
Universal |
Selective |
12 yrs |
NR |
NR |
NR |
NR |
NR |
NA |
NA |
NA |
NA |
NA |
Yes |
90 |
| Iceland (2011)§§ |
Selective |
Selective |
— |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
Yes |
50 |
| Ireland (2008) |
Universal |
Selective |
2, 4, 6 mos |
95 |
95 |
94 |
93 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
>95 |
| Israel (1998) |
Universal |
Universal |
B, 1, 6 mos |
95 |
97 |
96 |
96 |
Yes |
95 |
95 |
95 |
95 |
Yes |
— |
— |
| Italy (1982) |
Universal |
Selective |
2, 4, 11 mos |
93 |
94 |
95 |
95 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
97.7 |
| Kazakhstan (1998) |
Universal |
Universal |
B, 2, 4 mos |
82 |
99 |
98 |
97 |
Yes |
95 |
90 |
95 |
93 |
Yes |
— |
— |
| Kyrgyzstan (2001) |
Universal |
Universal |
B, 2, 3.5, 5 mos |
96 |
92 |
94 |
95 |
Yes |
96 |
97 |
97 |
96 |
Yes |
— |
— |
| Latvia (1997) |
Universal |
Selective |
2, 4, 6, 12–15 mos |
98 |
98 |
96 |
99 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
88 |
| Lithuania (1998) |
Universal |
Universal |
B, 1, 6 mos |
95 |
94 |
93 |
92 |
Yes |
97 |
97 |
97 |
97 |
Yes |
— |
— |
| Luxembourg (2003) |
Universal |
Selective |
2, 3, 13 mos |
94 |
94 |
96 |
96 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
95 |
| Malta (2005) |
Universal |
Selective |
12, 13, 18 mos |
97 |
88 |
98 |
98 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
100 |
| Moldova (1995) |
Universal |
Universal |
B, 2, 4, 6 mos |
90 |
89 |
94 |
94 |
No |
99 |
96 |
96 |
93 |
Yes |
— |
— |
| Monaco (1994) |
Universal |
Selective |
2, 4, 11 mos |
99 |
99 |
99 |
99 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Montenegro (2006) |
Universal |
Selective |
9, 13 wks, 9 mos |
75 |
73 |
72 |
72 |
No |
NA |
NA |
NA |
NA |
NA |
No |
— |
| Netherlands (2011)*** |
Universal |
Selective |
2, 3, 4–11 mos |
93 |
92 |
92 |
92 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
99 |
| North Macedonia (2004) |
Universal |
Universal |
B, 2, 6 mos |
94 |
91 |
92 |
92 |
Yes |
98 |
98 |
98 |
98 |
Yes |
— |
— |
| Norway (2017)*** |
Universal |
Selective |
3, 5, 12 mos |
NA |
NA |
NR |
96 |
ID |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Poland (1997) |
Universal |
Universal |
B, 7–8 wks, 7 mos |
95 |
93 |
91 |
91 |
Yes |
93 |
93 |
93 |
93 |
Yes |
— |
— |
| Portugal (1994) |
Universal |
Universal |
B, 2, 6 mos |
98 |
98 |
98 |
98 |
Yes |
97 |
97 |
97 |
97 |
Yes |
— |
— |
| Romania (1995) |
Universal |
Universal |
B, 2, 4, 11 mos |
90 |
92 |
93 |
90 |
Yes |
93 |
36 |
68 |
99 |
No |
— |
— |
| Russia (2000) |
Universal |
Universal |
B, 1, 6 mos |
97 |
97 |
97 |
97 |
Yes |
NR |
NR |
NR |
NR |
NR |
— |
— |
| San Marino (1995) |
Universal |
Selective |
3, 5, 11 mos |
86 |
82 |
78 |
87 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
100 |
| Serbia (2006) |
Universal |
Universal |
B, 4 wks, 10 mos |
91 |
93 |
91 |
94 |
Yes |
99 |
99 |
99 |
99 |
Yes |
— |
— |
| Slovakia (1997) |
Universal |
Selective |
2, 4, 10 mos |
96 |
96 |
96 |
97 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Slovenia (1998)¶¶,††† |
Universal |
Selective |
5 yrs (2 doses), 6 yrs |
88 |
89 |
87 |
88 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Spain (1996) |
Universal |
Selective |
2, 4, 11 mos |
97 |
95 |
96 |
96 |
Yes |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Sweden (2016) |
Universal |
Selective |
3, 5, 12 mos |
67 |
76 |
92 |
97 |
No |
NA |
NA |
NA |
NA |
NA |
Yes |
NR |
| Switzerland (2018)¶¶,§§§ |
Universal |
Selective |
2, 4, 12 mos; 11–15 yrs, +6 mos |
69 |
69 |
96 |
96 |
ID |
NA |
NA |
NA |
NA |
NA |
Yes |
97 |
| Tajikistan (2002) |
Universal |
Universal |
B, 2, 3, 4 mos |
97 |
96 |
96 |
97 |
Yes |
92 |
99 |
99 |
99 |
Yes |
— |
— |
| Turkey (1998) |
Universal |
Universal |
B, 1, 6 mos |
98 |
96 |
98 |
99 |
Yes |
99 |
99 |
99 |
99 |
Yes |
— |
— |
| Turkmenistan (2002) |
Universal |
Universal |
B, 2, 3, 4 mos |
98 |
99 |
99 |
99 |
Yes |
99 |
99 |
99 |
99 |
Yes |
— |
— |
| Ukraine (2003) |
Universal |
Universal |
8, 12, 16 wks |
26 |
52 |
67 |
76 |
No |
37 |
49 |
60 |
60 |
No |
— |
— |
| UK (2017)*** |
Universal |
Selective |
B, 2, 6 mos |
NA |
NA |
NR |
93 |
ID |
NA |
NA |
NA |
NA |
NA |
Yes |
>95 |
| Uzbekistan (2001) |
Universal |
Universal |
B, 2, 3, 4 mos |
99 |
99 |
98 |
96 |
Yes |
99 |
99 |
95 |
99 |
Yes |
— |
— |
| European Region¶¶¶ | — | — | — | 82 | 84 | 84 | 92 | — | 66 | 65 | 67 | 68 | — | — | — |
Abbreviations: B = birth; DTaP-Hib-HepB-IPV = hexavalent vaccine containing diphtheria and tetanus toxoids, acellular pertussis, Haemophilus influenzae type b, hepatitis B, and inactivated poliovirus components; HBsAg = hepatitis B virus surface antigen; HepB = hepatitis B vaccine; HepB3 = third dose of HepB; HepB-BD = birth dose of HepB; ID = insufficient data to determine (no reports for 1 or 2 years); NA = not applicable; NR = not reported; UK = United Kingdom; +6 mos = 6 months after the previous dose.
* https://immunizationdata.who.int
† Introduction of universal infant HepB vaccination into national immunization schedules. Exceptions: HepB was introduced regionally or subnationally before nationwide introduction in the following countries: Bosnia and Herzegovina (1999), Estonia (1999), Georgia (2000), Kyrgyzstan (1999), Poland (1995), Serbia (2002), Spain (1991), Sweden (2014), Ukraine (2001), and Uzbekistan (1997).
§ HepB vaccination policy: universal = all persons in the applicable age group (i.e., all infants, children aged 1–12 years, or adolescents aged 13–15 years for routine HepB vaccination, and all newborns for HepB-BD) receive HepB; selective = only infants born to mothers with positive HBsAg test results receive HepB vaccination, starting with HepB-BD.
¶ Two of the criteria for validation of hepatitis B control are 1) to achieve HepB3 coverage ≥90% for the 3 preceding years, applicable only to countries with universal infant HepB vaccination policy and 2) to achieve timely HepB-BD coverage ≥90% for the 3 preceding years, applicable only to countries with universal HepB-BD policy.
** A criterion for validation of hepatitis B control, applicable only to countries with selective HepB-BD policy; data for other countries not included. Sources: WHO 2018 Regional Office for Europe survey (Andorra, Austria, Belgium, Czechia, Estonia, France, Germany, Hungary, Ireland, Italy, Latvia, Malta, Monaco, Montenegro, the Netherlands, Norway, San Marino, Slovakia, Spain, and Switzerland); https://apps.who.int/iris/bitstream/handle/10665/85397/9789241564632_eng.pdf?sequence=1 (Cyprus, Denmark, Finland, Iceland, Luxembourg, Slovenia, and Sweden); reports submitted to the Regional Hepatitis B Working Group (Croatia and UK); https://europepmc.org/article/PMC/1475591 (Greece).
†† A criterion for validation applicable only to countries with selective HepB-BD policy. Sources: 2018 WHO Regional Office for Europe survey (Czechia, Germany, Italy, Latvia, San Marino, and Switzerland); https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/antenatal-screening-HIV-hepatitis-B-syphilis-rubella-EU.pdf (Belgium, Estonia, Hungary, Iceland, Ireland, Luxembourg, and Malta); reports submitted to the Regional Hepatitis B Working Group (Croatia, the Netherlands, and UK); https://en.ssi.dk/surveillance-and-preparedness/surveillance-in-denmark/annual-reports-on-disease-incidence/pregnancy-screening-2019 (Denmark); https://www.julkari.fi/bitstream/handle/10024/114883/URN_ISBN_978-952-302-057-3.pdf?sequence = 1&isAllowed = y (Finland); http://beh.santepubliquefrance.fr/beh/2015/15-16/pdf/2015_15-16_4.pdf (France); https://europepmc.org/article/PMC/1475591 (Greece).
§§ Denmark, Finland, and Iceland do not have universal HepB in their routine childhood immunization schedules but selectively vaccinate only infants born to mothers with positive HBsAg test results.
¶¶ Vaccination of older children or adolescents (Hungary, 12 years; Slovenia, 5–6 years; Switzerland, 11–15 years during 1997–2018, before switching to universal infant HepB immunization).
*** HepB was given only to infants of mothers with positive HBsAg test results before transition to universal infant vaccination in the Netherlands (2002–2010), Norway (2002–2016), and UK (2001– mid-2017).
††† Slovenia does not vaccinate infants against HepB; therefore, WHO/UNICEF estimates are not generated. Instead, country-reported official HepB3 coverage among children aged 6 years is included.
§§§ In Switzerland, reported coverage with HepB for adolescents until 2018. Since 2018, WHO/UNICEF estimates of coverage with the third dose of hepatitis B-containing hexavalent vaccine (DTaP-Hib-HepB-IPV) among infants (reported as DTP3).
¶¶¶ A weighted sum of WHO/UNICEF estimates of national coverage by target population from the United Nations Population Division's World Population Prospects for all 53 countries of the region. HepB3 coverage includes all 53 countries in EUR. HepB-BD coverage includes 23 countries that implement universal birth dose policy. Two countries, Bosnia and Herzegovina and Russia, do not report HepB-BD coverage, but their population is included in the denominator, resulting in lower coverage in this group than in most individual countries with reported coverage data.