, Volume 40, Issue 4, pp 405–413

Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007


    • Program in Public Health, Division of BiomedicineBrown University
  • A. Gjelsvik
    • Program in Public Health, Center for Population Health and Clinical EpidemiologyBrown University
  • E. Feller
    • Warren Alpert Medical SchoolBrown University
  • S. Rosenthal
    • Division of BiomedicineBrown University
  • B. T. Montague
    • Infectious DiseasesBrown University/Miriam Hospital
Clinical and Epidemiological Study

DOI: 10.1007/s15010-011-0241-2

Cite this article as:
Ladak, F., Gjelsvik, A., Feller, E. et al. Infection (2012) 40: 405. doi:10.1007/s15010-011-0241-2



In the USA, the burden of hepatitis B disproportionately affects high-risk adults who alone account for more than 75% of newly reported hepatitis B virus infections each year. Despite the localization of new infections in identifiable high-risk groups, vaccination rates in this subgroup, with the exception of health care workers, remain consistently low. The purpose of this study was to characterize those at risk for hepatitis B transmission and quantify the association between missed opportunities and hepatitis B vaccination.


Data from the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS) of adults aged 18 years and older who were at high risk for hepatitis B infection (n = 15,432) were analyzed. Multivariate regression analysis was conducted to determine factors independently associated with vaccination.


In a nationally representative sample, 51.4% of high-risk adults remained unvaccinated against hepatitis B and more than 50% had a missed opportunity for vaccination. High-risk adults who were vaccinated against pneumonia and influenza had a higher odds ratio of being vaccinated against hepatitis B than those not vaccinated against pneumonia and influenza (OR 2.27 and 1.67, respectively). Also, high-risk adults tested for human immunodeficiency virus (HIV) at a counseling and testing site or a drug treatment facility had a higher OR of being vaccinated than those who had not been tested for HIV (OR 1.78 and 1.73, respectively). The opposite relationship was true among individuals tested for HIV at a correctional facility (OR 0.60).


The findings of this study underscore the inadequacy of vaccination coverage in high-risk adults and highlight advantageous opportunities to bridge gaps in vaccination coverage.


Hepatitis B virusVaccinationPreventionHigh-risk adultsMissed opportunities

Copyright information

© Springer-Verlag 2012