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Hepatitis B vaccination coverage among high-risk adults 18–49 years, U.S., 2009

Lu, Peng-jun, Byrd, Kathy K., Murphy, Trudy V., Weinbaum, Cindy
Vaccine 2011 v.29 no.40 pp. 7049-7057
Hepatitis B virus, vaccination, adults, relative risk, adolescents, sexually transmitted diseases, females, men, risk factors, hepatitis B, children, blood coagulation factors, higher education, vaccines, surveys, health care workers, regression analysis, drug injection, influenza, hemophilia, United States
BACKGROUND: Approximately 43,000 new hepatitis B virus (HBV) infections occurred in 2007. Although hepB vaccination has been recommended for adults at high-risk for incident HBV infection for many years, coverage remains low. METHODS: We used the 2009 National Health Interview Survey to assess self-reported HepB vaccine uptake (≥1 dose), series completion (≥3 dose), and independent predictors of vaccination among high-risk adults aged 18–49 years. High-risk adults were defined as those reporting male sex with men; injection drug use; hemophilia with receipt of clotting factors; sexually transmitted disease in prior five years; sex for money or drugs; HIV positive; sex with persons having any above risk factors; or who “felt they were at high risk for HIV”. Persons with none of the aforementioned risk factors were considered non-high risk. Bivariate analysis was conducted to assess vaccination coverage. Independent predictors of vaccine uptake and series completion were determined using a logistic regression. RESULTS: Overall, 7.0% adults aged 18–49 years had high-risk behaviors. Unadjusted coverage with ≥1 dose was 50.5% among high-risk compared to 40.5% among non-high-risk adults (p-values <0.001) while series completion (≥3 doses) was 41.8% and 34.2%, respectively (p-values <0.001). On multivariable analysis, ≥1 dose coverage, but not series completion, was higher (Risk Ratio 1.1, 95% CI=1.0–1.2, p-value=0.021) among high-risk compared to non-high risk adults. Other characteristics independently associated with a higher likelihood of HepB vaccination among persons 18–49 years included younger age groups, females, higher education, ≥2 physician contacts in the past year, ever tested for HIV, health care personnel, received influenza vaccination in the previous year, and ever received hepatitis A vaccination. Vaccine uptake with ≥1 dose increased by 5.1% (p=0.047) among high-risk adults between 2004 and 2009. CONCLUSIONS: A small increase in ≥1 dose HepB vaccination coverage among high-risk adults compared with non-high risk adults was documented for the first time in 2009. Higher coverage among persons 18–30 years may reflect aging of persons vaccinated when they were children and adolescents. To improve protection against hepatitis B among high-risk adults, healthcare providers should offer hepatitis B vaccination to persons at high risk and those who seek vaccination to protect themselves and facilitate timely completion of the three (3) dose HepB series.