, 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

  • F. Ladak
  • A. Gjelsvik
  • E. Feller
  • S. Rosenthal
  • B. T. Montague
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 virus Vaccination Prevention High-risk adults Missed opportunities 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • F. Ladak
    • 1
    • 6
  • A. Gjelsvik
    • 2
  • E. Feller
    • 3
  • S. Rosenthal
    • 4
  • B. T. Montague
    • 5
  1. 1.Program in Public Health, Division of BiomedicineBrown UniversityProvidenceUSA
  2. 2.Program in Public Health, Center for Population Health and Clinical EpidemiologyBrown UniversityProvidenceUSA
  3. 3.Warren Alpert Medical SchoolBrown UniversityProvidenceUSA
  4. 4.Division of BiomedicineBrown UniversityProvidenceUSA
  5. 5.Infectious DiseasesBrown University/Miriam HospitalProvidenceUSA
  6. 6.BarringtonUSA

Personalised recommendations