A primary indicator of the positive impact of hepatitis B vaccination is a reduction of the seroprevalence of HBsAg in the vaccinated population[13]. in schoolchildren (11.8%) and the military (10.6%). Consequently, the anti-HBs prevalence increased with age, from 21.2% in schoolchildren (mean age: 15.7 years), to 36.3% in pregnant women (mean age: 26.3 years) and 29.7% in voluntary blood donors (mean age: 40.1 years). There were no significant differences between males and females. CONCLUSION: Despite the estimated two-fold reduction of HBsAg prevalence in the general population from about 18%-19% to 9.5%, Albania remains a highly endemic country (i.e. over 8% of HBsAg prevalence rate). strong class=”kwd-title” Keywords: Albania, Hepatitis B virus, Blood donor, Military, Pregnant women, Schoolchildren, Student INTRODUCTION Hepatitis B is a disease of global distribution. It is estimated that about 30% of the worlds population, i.e. approximately 2 billion people, show serological evidence of hepatitis B virus (HBV) infection and about 40 million are persistent carriers of HBV [1]. Each year over one million people die from HBV-related chronic liver disease, including cirrhosis and hepatocellular carcinoma[2]. The endemicity of HBV infection varies greatly worldwide and is influenced primarily by the age at which infection occurs[3,4]. In Europe, the level of endemicity increases from north to south and from west to east. Most countries of northern and western Europe have a very low prevalence of HBV infection (less than SNT-207707 0.5% of the population being positive for HBsAg). Unexpectedly high prevalence of hepatitis B carriage (5%-12%) have been found in many parts of central and Eastern Europe and the former Soviet Union SNT-207707 countries[5,6]. Endemicity of infection is considered high in those parts of the world where at least 8% of the population is HBsAg positive. Almost all infections occur either during the prenatal period or early in a childhood, which accounts for the high rates of chronic HBV infection in these populations[7]. Credible epidemiological data of HBV infection in Albania, before the introduction of obligatory vaccination of newborn children against HBV (1995), was obtained by screening Albanian refugees during the first mass scale migration from Albania to Italy and Greece that occurred in 1991[8C10]. Although the refugees represented mostly subjects from lower socio-economic classes, the large number of people enrolled from different geographic areas (rural and urban) provided important information on HBV infection in Albania (Table ?(Table1).1). The presence of one or more serological markers of HBV infection and the high rate of infection in children aged 1 to 10 years confirms the endemic nature of this virus in Albania. Table 1 Prevalence of hepatitis B markers in Albanian refugees according to studies in Italy and Greece thead align=”center” AuthorSanantonio et alDalekos et alMalamitsi-Puchner et al /thead Study regionBariIoanninaAthensYr199319951996AgesAdultsAll agesPregnant womenNo. cases3931025500% prevalence of HBsAg1922.213.4% prevalence of anti-HBs555253 Open in a separate window The above-mentioned data of HBV infection in Albania were undoubtedly related to low hygiene and poor SNT-207707 economic situation, overcrowded conditions, lack of disposable needles and syringes, lack of safe blood and its products for transfusion, inadequate B2M sterilization of reusable equipment, difficulties in obtaining appropriate personal equipment to prevent exposure to blood, and lack of SNT-207707 an immunization program against HBV. In 1992, WHO recommended that all countries should include hepatitis B vaccine in their routine infant immunization programs. Since May 1995, thanks to the Rotary International Club, Albania introduced vaccination of newborn children against HBV into the National Immunization Programs as the most appropriate immunization strategy to reduce the rate of HBV infection and HBV-related chronic liver diseases. Infants are immunized at birth, and then after 1 and 5 mo. MATERIALS AND METHODS Blood samples from 3880 randomly selected non-vaccinated residents of rural and urban areas from all over Albania were tested during 2004-2006 for HBsAg and anti-HBs by ELISA The blood samples were obtained from 2354 (60.7%) males and 1526 (39.3%) females SNT-207707 (mean age of 26.3 years) comprising 410 schoolchildren, 666 students, 500 military, 1286 casual blood donors, 378 voluntary blood donors and 640 pregnant women. Casual blood donors included individuals who donated blood only once, whereas voluntary blood donors included regular.