Predictors of completion of a hepatitis B vaccination schedule in attendees at a primary health care centre
Virginia Macdonald A , Gregory J. Dore B , Janaki Amin B and Ingrid van Beek A CA The Kirketon Road Centre, South Eastern Sydney and Illawarra Area Health Service, Sydney, NSW 2011, Australia.
B The National Centre in HIV Epidemiology and Clinical Research, University of NSW, Sydney, NSW 2010, Australia.
C Corresponding author. Email: Ingrid.VanBeek@sesiahs.health.nsw.gov.au
Sexual Health 4(1) 27-30 https://doi.org/10.1071/SH06008
Submitted: 30 January 2006 Accepted: 16 June 2006 Published: 26 February 2007
Abstract
Background: In Australia, rates of hepatitis B (HBV) transmission continue to be higher in certain populations, including commercial sex workers and injecting drug users (IDU). This study aims to identify rates and predictors of completion of a HBV vaccination schedule in ‘high-risk’ attendees of a primary health care centre in Sydney. Methods: All clients who attended Kirketon Road Centre, a primary health care centre located in Kings Cross, Sydney, with no evidence of HBV immunity were included in the cohort. The study design was observational with historical controls. The main outcome measure was completion of a three-dose HBV vaccine schedule in the study period. Results: Among 2085 clients who received a first vaccination, 1013 (49%) received a second and 435 (21%) received a third vaccination. Univariate analysis found that significant predictors of completion of the vaccine schedule were intention to administer an accelerated schedule (OR 1.49, P = 0.004), not being an IDU (OR 1.29, P = 0.02) and shorter time between first visit and first vaccine dose (OR 1.24, P for trend <0.0001); however, on multivariate analysis, not being an IDU was no longer a predictor of vaccine completion. Conclusion: Implementation of an accelerated vaccination schedule improved completion rates but they were still low, despite the provision of free vaccination in a service specifically targeting the needs of sex workers, IDU and other marginalised populations. Increasing HBV vaccine uptake and completion rates in Australian adults is an important public health issue not only for the prevention of HBV but also for the future application of other potential vaccines, including those against HIV and hepatitis C.
Acknowledgements
We would like to thank the clients and staff of the Kirketon Road Centre for their participation in this study and Dr Lisa Maher and Dr Carolyn Day of the National Centre in HIV Epidemiology and Clinical Research for their comments on earlier drafts of this paper.
[1] Williams A. Reduction in hepatitis B related burden of disease – measuring the success of universal immunisation programs. Commun Dis Intell 2002; 26(3): 458–60.
| PubMed |
[2] Kao J-H, Chen D-S. Global control of hepatitis B virus infection. Lancet Infect Dis 2002; 2 395–403.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[3]
[4] O’Sullivan BG, Gidding HF, Law M, Kaldor JM, Gilbert GL, Dore GJ. Estimates of chronic hepatitis B virus infection in Australia, 2000. Aust N Z J Public Health 2004; 28 212–6.
| PubMed |
[5] van Steenbergen JE. Results of an enhanced-outreach programme of hepatitis B vaccination in the Netherlands (1998–2000) among men who have sex with men, hard drug users, sex workers and heterosexual persons with multiple partners. J Hepatol 2002; 37 507–13.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[6] Minuk GY, Sun DF, Greenberg R, Zhang M, Hawkins K, Uhanova J, et al. Occult hepatitis B virus infection in a North American adult hemodialysis patient population. Hepatology 2004; 40(5): 1072–7.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[7] Anderson B, Bodsworth NJ, Rohrsheim RA, Donovan BJ. Hepatitis B virus infection and vaccination status of high risk people in Sydney: 1982 and 1991. Med J Aust 1994; 161 368–71.
| PubMed |
[8] Crofts N, Aitken CK. Incidence of bloodborne virus infection and risk behaviours in a cohort of injecting drug users in Victoria, 1990–1995. Med J Aust 1997; 167 17–20.
| PubMed |
[9] Kaldor JM, Plant AJ, Thompson SC, Longbottom H, Rowbottom J. The incidence of hepatitis B infection in Australia: an epidemiological review. Med J Aust 1996; 165 322–6.
| PubMed |
[10] van Beek I, Buckley R, Stewart M, MacDonald M, Kaldor . Risk factors for hepatitis C virus infection among injecting drug users in Sydney. Genitourin Med 1994; 70(5): 321–4.
| PubMed |
[11] Sterling RK, Sulkowski MS. Hepatitis C virus in the setting of HIV or hepatitis B coinfection. Semin Liver Dis 2004; 24 61–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[12] Maher L, Chant K, Jalaludin B, Sargent P. Risk behaviours and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia. J Gastroenterol Hepatol 2004; 19(10): 1114–20.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[13] Day C, White B, Ross J, Dolan K. Poor knowledge and low coverage of hepatitis B vaccination among injecting drug users in Sydney. Aust NZ J Public Health 2003; 27(5): 558.
| PubMed |
[14] Saltoglu N, Inal AS, Tasova Y, Kandemir O. Comparison of the accelerated and classic vaccination schedules against Hepatitis B: three-week Hepatitis B vaccination schedule provides immediate and protective immunity. Ann Clin Microbiol Antimicrob 2003; 2(1): 10–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[15] Marchout B, Picot N, Chavanet P, Auvergnat JC, Armengaud M, Devilliers P, et al. Three-week hepatitis B vaccination provides protective immunity. Vaccine 1993; 11(14): 1383–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[16] Rogers N, Lubman DI. An accelerated schedule for young drug users. Aust N Z J Public Health 2005; 29(4): 305–7.
| PubMed |
[17] Harries AD, Clark M, Beeching NJ, Lavelle J, Mutton KJ. Early anti-HBs antibody response to accelerated and to conventional hepatitis B vaccination regimens in healthy persons. J Infect 1991; 23(3): 251–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[18] McGregor J, Marks PJ, Hayward A, Bell Y, Slack RC. Factors influencing hepatitis B vaccine uptake in injecting drug users. J Public Health Med 2003; 25(2): 165–70.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[19] Richter A, Anton SE, Koch P, Dennett SL. The impact of reducing dose frequency on health outcomes. Clin Ther 2003; 25(8): 2307–35.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[20] ul-Haq N, Hasnain SS, Umar M, Abbas Z, Valenzuela-Silva C, Lopez-Saura P. Immunogencity of 10 and 20 microgram hepatitis B vaccine in a two-dose schedule. Vaccine 2003; 21(23): 3179–85.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[21] Seal KH, Kral AH, Lorvick J, McNees A, Gee L, Edlin BR. A randomised controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug Alcohol Depend 2003; 71 127–31.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
