Open Access Research article

Effects of an ageing population and the replacement of immune birth cohorts on the burden of hepatitis A in the Netherlands

Scott A McDonald1*, Marie-Josée J Mangen2, Anita Suijkerbuijk3, Edoardo Colzani4 and Mirjam EE Kretzschmar12

Author Affiliations

1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

2 Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

3 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

4 European Centre for Disease Prevention and Control, Stockholm, Sweden

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BMC Infectious Diseases 2013, 13:120  doi:10.1186/1471-2334-13-120

Published: 5 March 2013



In populations in which the incidence of hepatitis A virus (HAV) infection has declined due to socio-economic improvements, better sanitation and hygiene, and vaccination, birth cohorts who have long-term immunity through exposure early in life are now being replaced by non-immune cohorts, meaning that more cases in the elderly may occur in future. Our goal was to qualitatively investigate the interaction of this cohort effect and demographic change (population ageing) on the estimated disease burden of HAV infection in the Netherlands.


We used dynamic MSIR (maternal immunity–susceptible–infectious–recovered) transmission and demographic models to simulate annual HAV incidence over the period 2000–2030, and estimated disease burden using the disability-adjusted life years (DALY) measure and a pre-defined disease progression model. Five scenarios representing different force of infection situations were simulated.


The overall disease burden was projected to decrease over the simulation period in the baseline scenario (310 DALYs in 2000 compared with 67 in 2030). This decreasing trend was absent for the 55+ years age group; 23.5% of all new infections were predicted to occur in the 55+ group in 2030, compared with 5.5% in the 55+ group in 2000.


In the absence of further public health interventions and under the assumption of a continued steady decline in the force of infection, the HAV disease burden in the Netherlands is predicted to decrease over the coming decades, but with proportionally more of the burden occurring within the increasingly larger segment of the population represented by elderly persons who are no longer naturally immune.

Hepatitis A virus; Dynamic transmission model; Disability-adjusted life-years; Natural immunity; Population ageing