Unexpected rise in the circulation of complex HBV variants enriched of HBsAg vaccine-escape mutations in HBV genotype-D: potential impact on HBsAg detection/quantification and vaccination strategies.

This sub-genotype is known to be largely spread in East-Europe, underling the importance of monitoring the emergence of mutations, potentially hampering the full efficacy of anti-HBV vaccination, in the setting of non-autochthonous HBV sub-genotypes. Notably, multivariable analysis showed an increased risk of harbouring at least one vaccine escape mutation in the time-window 2015–2019 compared to 2005–2009 (1.60[0.99–2.60], P = 0.05) ( Table 3 ), supporting an increasing trend in the circulation of these mutations over time.

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