Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007
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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.
- Centers for Disease Control and Prevention: Disease burden from viral hepatitis A, B, and C in the United States. Available at:http://www.cdc.gov/ncidod/diseases/hepatitis/resource/PDFs/disease_burden2002.pdf. Accessed 27 Nov 2010.
- Rich, JD, Ching, CG, Lally, MA, Gaitanis, MM, Schwartzapfel, B, Charuvastra, A, Beckwith, CG, Flanigan, TP (2003) A review of the case for hepatitis B vaccination of high risk adults. Am J Med 114: pp. 316-318 CrossRef
- Centers for Disease Control and Prevention. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations from the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR 2006;55:1–25. http://www.cdc.gov/mmwr/pdf/rr/rr5516.pdf.
- Wasley, A, Moran, DK, Kuhnert, W, Simard, EP, Finelli, L, McQuillan, G, Bell, B (2010) The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis 202: pp. 192-201 CrossRef
- Ndiaye, SM, Hopkins, DP, Shefer, AM, Hinman, AR, Briss, PA, Rodewald, L, Willis, B (2005) Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high risk adults. Am J Prev Med 28: pp. 248-279 CrossRef
- Nidhi, J, Yusuf, H, Wortley, PM, Euler, GL, Walton, S, Stokley, S (2004) Factors associated with receiving the hepatitis B vaccination among high-risk adults in the United States: an analysis of the national health interview survey, 2000. Fam Med 36: pp. 480-486
- Mackeller, DA, Valleroy, LA, Secura, GM (2001) Two decades after the vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health 91: pp. 965-971 CrossRef
- Center for Disease Control and Prevention. Achievements in public health: hepatitis B vaccination—United States, 1982–2002. MMWR Morb Mortal Wkl Rep 2002;51:549–53, 563.
- Hepatitis B vaccination among high-risk adolescents and adults—San Diego, California, 1998–2001. MMWR Morb Mortal Wkl Rep 51: pp. 618-621
- IOM (Institute of Medicine). Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. The National Academies Press, Washington, DC; 2010.
- Centers for Disease Control and Prevention (CDC). Improving influenza, pneumococcal polysaccharide and hepatitis B vaccination coverage among adults <65 years at high risk: a report on recommendations of the task force on community preventative services. MMWR 2005;54(RR-5).
- Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey questionnaire. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta; 2007.
- Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey data. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta; 2007.
- Harpaz, R, McMahon, BJ, Margolis, HS, Shapiro, CN, Havron, D, Carpenter, G (2000) Elimination of new chronic hepatitis B virus infections: results of the Alaska immunization program. J Infect Dis 181: pp. 413-418 CrossRef
- Agladioglu, S, Beyazova, U, Camurdan, AD, Sahin, F, Atak, A (2010) Immunogenicity of recombinant hepatitis B vaccine: comparison of two different vaccination schedules. Infection 38: pp. 269-273 CrossRef
- Centers for Disease Control and Prevention. Hepatitis B vaccination coverage among adults–United States 2004. MMWR 2006;55:509–511. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5518a3.htm
- StataCorp. Stata statistical software: release 10. StatCorp, College Station; 2007.
- Owens, GM (2008) Gender differences in health care expenditure, resource utilization and quality of care. J Manag Care Pharm 14: pp. S2-S6
- Joung, MA, Vander der Meer, JB, Mackenback, JP (1994) Marital status and health care utilization. Int J Epidemiol 24: pp. 569-575 CrossRef
- Bevier, P, Chamont, E, Gallachi, MB, Loutan, L (2001) Importance of patient’s perceptions and general practitioner’s recommendations in understanding missed opportunities for immunizations in Swiss adults. Vaccine 19: pp. 4760-4767 CrossRef
- Orenstein, WA, Mootrey, GT, Pazol, K, Hinman, AR (2007) Financing immunization of adults in the United States. Clin Pharmacol Ther 82: pp. 764-768 CrossRef
- Hinman, AR, Orenstein, WA (2007) Adult immunization: what can we learn from the childhood immunization program?. Clin Infect Dis 44: pp. 1532-1535 CrossRef
- Hepatitis B Foundation. Hepatitis B vaccination. Available at: http://www.hepb.org/hepb/vaccine_information.htm. Accessed 10 May 2010.
- Rosenbaum S, Stewart A, Cox M, Lee A. Medicaid coverage of immunization in non-institutionalized adults. Center for Health Services Research and Policy, George Washington University, Washington, DC; 2003. Available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/CHPR/downloads/Medicaid_Immunization_Study.pdf. Accessed 27 Feb 2011.
- Daley, MF, Henessey, KA, Weinbaum, CM, Stockley, S, Hurly, LP, Crane, LA (2009) Physician practices regarding adult hepatitis B vaccination. Am J Prev Med 36: pp. 491-496 CrossRef
- Cabana, MD, Rand, CS, Powe, NR, Wu, AW, Wilson, MH, Abboud, PC, Rubin, HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282: pp. 1458-1465 CrossRef
- Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007
Volume 40, Issue 4 , pp 405-413
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Hepatitis B virus
- High-risk adults
- Missed opportunities
- Industry Sectors
- Author Affiliations
- 1. Program in Public Health, Division of Biomedicine, Brown University, 121 South Main Street, Box G, Providence, RI, 02903, USA
- 6. 72 Orchard Avenue, Barrington, RI, 02806, USA
- 2. Program in Public Health, Center for Population Health and Clinical Epidemiology, Brown University, 121 South Main St. S121-2, Providence, RI, 02912, USA
- 3. Warren Alpert Medical School, Brown University, Box G-S121, 121 South Main Street, Providence, RI, 02912, USA
- 4. Division of Biomedicine, Brown University, 121 South Main Street, Box G, Providence, RI, 02903, USA
- 5. Infectious Diseases, Brown University/Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA