The impact of hepatitis B vaccination in men having sex with men in Amsterdam has been marginal until now, possibly because of increases in sexual risk behaviour counterbalancing the effect of vaccination. A mathematical model is used to describe the hepatitis B epidemic. The model shows that, with the current vaccination coverage, the decrease in incidence is small in the beginning. However, the number of infections prevented per vaccine administered rises over time. Nevertheless, increased risk behaviour reduces the benefit of vaccination. Targeting high-risk men is more successful in reducing and containing the epidemic than targeting low-risk men. In conclusion, the vaccination campaign is effective and should be intensified. High-risk men should be targeted for vaccination and for risk reduction.

This study examined possible neuroendocrine mechanisms underlying the association between stress and antibody response to vaccination. Hepatitis B antibody titers were obtained, and salivary cortisol and cardiovascular activity measured during baseline, mental arithmetic, and recovery in 30 undergraduates. It was hypothesised that higher reactivity would be associated with poorer antibody status. Compared to individuals with high antibody titers, those with low titers had significantly lower cortisol levels throughout, exhibited a significantly attenuated end-of-task reduction in cortisol relative to resting baseline, and had larger cardiac output and inotropic reactions, but smaller increases in total peripheral resistance, to mental arithmetic. In sum, variations in indices of both hypothalamic pituitary adrenocortical axis and sympathetic nervous system activity were associated with individual differences in immune response to vaccination.