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FACTORS ASSOCIATED WITH RECEIPT OF HEPATITIS B VACCINE AMONG HIGH RISK ADULTSNATIONAL HEALTH INTERVIEW SURVEY, 2000Nidhi Jain MD MPH

Acknowledgements Hussain Yusuf MBBS MPH Pascale Wortley MD MPH Shannon Stokley MPH Gary Euler DrPH Sabrina Walton MSPH James Singleton MD

Objectives • Understand factors associated with receipt of hepatitis B vaccine among high risk adults 18-49 years of age • Encourage discussion regarding effective strategies to vaccinate this group

Background • In general, adult vaccination rates are lower than childhood rates • Hepatitis B vaccination has been recommended for adults with certain high risk behaviors • Hepatitis B vaccination can prevent acute and chronic liver disease

Adult high-risk groups • Persons with a history of sexually transmitted diseases (STDs) • Men who have sex with men • Injection drug users (street drugs) • Persons with hemophilia or other blood clotting disorders and received factors • Household or sexual contacts with Hepatitis B infected persons

Adult high risk groups (cont.) • Health Care Workers • Heterosexually active persons with multiple partners • Immigrants from high endemic areas • Others

Methods • Analysis of National Health Interview Survey (NHIS), 2000 • Annual face-to-face survey • Non-institutionalized US residents • Examines current health indices and health care practices

Methods (cont.) Criteria for Inclusion in this study • Any history of sexually transmitted diseases in past 5 years and/or ever having one or more of the following: • History of hemophilia and received blood clotting factors • Being a man who has had sex with men • Used intravenous street drugs • Traded sex for money or drugs • Tested positive for Human Immunodeficiency Virus (HIV) • Had sexual contact with anyone with any of the above risk factors

Methods (cont.) • Weighted analysis with SUDAAN • Bivariate analysis using chi-square test • Assess significant characteristics associated with receipt of at least one dose of hepatitis B vaccine by high-risk adults 18-49 years old

Results • Of 32,374 respondents, 1091 adults (3%) between 18-49 years old reported high-risk characteristics

Results (cont.) • Only 32.6% of high-risk adults identified by this survey reported ever having received at least one dose of hepatitis B vaccination (n=365) • Only 23.0% reported receiving the three-dose series (n=249)

Characteristics associated with >1 doses hepatitis B vaccine among high-risk adults 18-49 y/o

Factors not associated with hepatitis B vaccination • Gender • Race/ethnicity • Educational level attained • Employment status • Income • Region living in the US • Insurance status (Covered/not covered)

Conclusion • Hepatitis B vaccination rates among high-risk adult groups are overall low • Greater efforts are needed to vaccinate this group • We need to avoid missed opportunities

Conclusions (cont.) • Factors associated with receipt of hepatitis B vaccine among high-risk adults include: • Having a source of primary care • Having more than one clinic visit in a year • Having a pneumococcal or current year influenza vaccine • Having ever had an HIV test • Having ever donated blood

Limitations • Self-reported information regarding high risk factors • Self-reported vaccination status- not provider verified • Occupation was not accounted for in assessing vaccination status • Health care utilization in the past year does not adequately reflect lifetime receipt of hepatitis B vaccine

Recommendations • Encourage using primary care services for immunizations • Regular use of health care (more than once a year) should be emphasized • Providers should not forget about older age groups who may be high-risk

Recommendations (cont.) • Investigate the use of non-traditional settings for vaccination—ie. HIV testing centers, blood donation centers and STD clinics to increase coverage levels • Use evidence-based strategies to raise coverage levels—such as Client or Provider education within multi-component interventions

Thank you!

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