1. Hepatitis B Vaccination Coverage among High-risk Adults Aged 18 - 49 Years, United States, 2008
Pengjun Lu, PhD, MPH;1 Kathy Byrd, MD, MPH;2
Trudy Murphy, MD;2 Cindy Weinbaum, MD, MPH;2
1Immunization Services Division,
National Center for Immunization and Respiratory Diseases,
2 Division Of Viral Hepatitis, National Center for HIV/AIDS,
Viral Hepatitis, STD,& TB Prevention
Centers for Disease Control and Prevention

2. Hepatitis B (HBV) Disease Burden, United States
Hepatitis B causes significant morbidity
1 in 20 persons ever infected with hepatitis B virus (12.5 million)
43,000 persons newly infected in 2007
95% of new cases were in adults
800,000 – 1.4 million persons with chronic HBV infection
2,000 – 4,000 deaths / year

3. Incidence of Acute Hepatitis B, 1980 - 2006
Vaccine for
certain groups
(1982)
All Infant immunization
(1991)
All birth dose
(2005)
All Adolescent immunization
(1995)
Recombinant
vaccine
licensed
(1986)
Adults at risk (2006)
This slide shows the rate of new cases of acute hepatitis B from 1980 – 2006.
Cases of acute hepatitis B peaked around 1985 and have since steadily declined. From 1985 to 2006 the incidence has decreased 86%.
Several strategies to decrease hepatitis B transmission where implemented over this time period.
In 1982 vaccination for hepatitis B was recommended for certain groups.
The recombinant hepatitis B vaccine was licensed in 1986.
Universal infant vaccination was recommended in 1991 with routine vaccination of previously unvaccinated children and adolescents in 1995.
And universal vaccination of newborns was recommended in 2005.

4. Revised Hepatitis B Vaccine Recommendations for Adults (2006)
High risk adults, including
Household contacts and sex partners of HBV carriers
Injecting drug users
Men who have sex with men
Multiple sex partners
HIV positive
Hemodialysis patients
Hemophilia with clotting factors
Universal vaccination in settings serving high-risk adults
Partially based on the data that I just showed you, in 2006, the Advisory Committee on Immunization Practices revised their recommendations for hepatitis B vaccination in adults
To include universal hepatitis B vaccination for settings serving adults at high risk for hepatitis B infection including:
STD clinics
HIV testing and treatment facilities
Correctional facilities including both prisons and jails
Substance abuse treatment facilities and
Others such as institutions for the developmentally disabled

5. Study Objective
Estimate HBV vaccination coverage in high-risk adults aged 18 – 49 years
2008 National Health Interview Survey

6. National Health Interview Survey (NHIS)
In-home household interview survey
Conducted by U.S. Census Bureau for the National Center for Health Statistics
Civilian non-institutionalized population residing in the United States
Random sample of ~48,000 households annually
Over 20,000 respondents in 2008

7. Methods
Weighted proportion of self-reported HBV vaccination coverage (≥1 dose) determined by risk group and characteristic
Age group
Sex
Race / ethnicity
Education level
Above high school or high school and below
Insurance status
Ever tested for HIV

8. Case Definition: Risk Group
High risk: any of the following apply
Male sex with men
Injection drug use
Hemophilia with clotting factors
Sex for money or drugs
HIV positive
Sex with any of the above
Multiple sexual partners
STD in past 5 years (other than HIV)
or responded that HIV risk was high
Low risk: none of the above

9. Analysis
Comparison of vaccination coverage (high versus low risk) by age groups using Pearson’s Χ2 test
Independent predictors of vaccination determined by multivariate logistic regression
Vaccination coverage compared with the 2004 NHIS estimation of coverage in high-risk adults

10. Demographics and Characteristics of Persons aged 18 – 49 years
“High risk”
“Low risk”
Median age (years) 34 35 n %
Total (unweighted)
852
6.6
10,859
93.4
Male
366
47.6
4,897
49.6
White, non-Hispanic
455
63.3
5,941
63.9
Some college
504
56.8
6,544
60.3
Has health insurance
595
72.5
8,302
77.9
Ever tested HIV
653
75.4
5,516
48.3

11. Proportion of all Adults who Received ≥1dose of HBV vaccine, by Age group
Include a bar for “total” e.g. all adults 18 years of age and older

12. Proportion of Adults who Received ≥1dose of HBV vaccine, by Age and Risk Groups* * *
* p-value < 0.05

13. Proportion of High-risk Adults who Received ≥ 1 dose of HBV vaccine, by Age group and Year, NHIS 2004 and 2008
*MMWR 2006, Vol. 55, no. 18

14. Independent Predictors of Vaccination
aOR
95% CI
95 % CI
Age group
Race / ethnicity
18 – 20
referent
---
White, nh
21 – 25
0.6
Black, nh
0.8
26 – 30
0.3
Other, nh
0.9
31 – 39
0.2
Hispanic
41 – 49
Some college
1.9
High-risk
1.2
Has insurance
1.5
Female Sex
Ever tested HIV

15. Limitations
Self-reported hepatitis B vaccination status was not verified by a chart review
Institutionalized adults were not included in the survey
NHIS population (well educated and insured) might not be representative of the general U.S. population

16. Conclusions
Although recommended for vaccination, high risk individuals were no more likely to be vaccinated than low risk individuals
Overall, vaccination coverage among high-risk individuals has not changed substantially since 2004

17. Recommendations
Providers should ensure that high-risk persons are offered vaccination
Use of evidence-based immunization strategies such as standing orders and patient reminder / recall systems should be considered to increase vaccination
Adult immunization registries should be considered to track adult immunizations

18. Acknowledgements NCHS for collecting the data
The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention (CDC) and should not be construed to represent any CDC determination or policy