Many high-risk Americans don’t get hepatitis B vaccine

Although there is an effective vaccine for hepatitis B and public health officials have a strong sense of who is at highest risk for the infectious liver disease, tens of thousands of people in the United States contract the virus every year. According to a new study by researchers at Brown University, missed opportunities to administer the vaccine continue to be a reason why infections persist.

“This is a really simple thing that we could do and if somebody ends up getting the disease because we didn’t make the effort then I think that’s really a shame,” said Brian Montague, assistant professor of medicine in the Warren Alpert Medical School of Brown University and a physician at The Miriam Hospital.

Yet in an analysis published Jan. 12, 2012, in advance online in the journal Infection, senior author Montague and lead author Farah Ladak found that in a nationally representative sample of high-risk adults, 51.4 percent said they were unvaccinated. More than half of them had the potential to receive the vaccine based on their reported contact with health care providers.

The study is based on responses by more than 15,000 adults to the 2007 Behavioral Risk Factor Surveillance Survey, which gathers health information from more than 430,000 people across the United States. The respondents in the study’s analysis acknowledged engaging in risk behaviors such as certain sexual practices or needle drug use and could definitively report their hepatitis B status. Previous research has found that more than 95 percent new infections in adults occur among people with such behavioral risk factors.

Montague, Ladak, and their co-authors sought to figure out who among this highly vulnerable population was going unvaccinated and whether and where they could have received the three required shots.

When did hepatitis B vaccine become available? The first hepatitis B vaccine became commercially available in the United States in 1982. In 1986, a hepatitis B vaccine produced by recombinant DNA technology was licensed, and a second recombinant-type hepatitis B vaccine was licensed in 1989. The two recombinant DNA vaccines (Recombivax HB and Engerix-B) are the only hepatitis B vaccine preparations currently used in the United States. (There are additional products licensed in the U.S. that contain these vaccines in combination with other vaccines.)

They found that vaccinations were relatively infrequent among adults older than 33 (vaccinations have increased markedly in children since the 1990s), among people with less access to health insurance, and among people who have also not been vaccinated against other diseases such as the flu.

But even among people with access to health care, including people who reported specific contact with health care providers, thousands of people went unvaccinated, Ladak said. The study identifies places where improved vaccine delivery would make a substantial difference - for instance when people are tested for HIV, such as at the doctor’s office, in a hospital or clinic, and especially in jail.