1. Hepatitis B Vaccination Assessment Adults Aged 18-64 Years National Health Interview Survey, 2000
Gary L. Euler, DrPH1, Hussain Yusuf, MBBS2, Shannon Stokley, MPH2, Sabrina E. Walton, MSPH3, James A. Singleton, MS1
1Viral Vaccine-Preventable Diseases Branch, Epidemiology and Surveillance Division, NIP, CDC 2Health Services Research and Evaluation Branch, Immunization Services Division, NIP, CDC 3DynCorp, A CSC Company

2. Acute Hepatitis B in the U.S.
81,000 estimated cases of acute hepatitis B in the U.S., 2000
Most occurred in adults in known risk groups
Most had missed opportunities for vaccination
22,000 figure provided 12/05/02 by Annemarie Wasley, DVH

3. Adult Risk Groups for Hepatitis B – 1
Persons with history of STD
Persons with multiple sex partners (>1 partner / 6 months)
Men who have sex with men
Injecting drug users
Incarcerated persons
Immigrants from countries with HBV prevalence ≥2%
Hepatitis B vaccination has been recommended for persons with risk factors for HBV infection since the vaccine was licensed in 1981

4. Adult Risk Groups for Hepatitis B – 2
Household and sex contacts of HBV-infected persons
Healthcare and public safety workers who have exposure to blood in the workplace
Hemodialysis patients
Recipients of clotting-factor concentrates
Hepatitis B vaccination has been recommended for persons with risk factors for HBV infection since the vaccine was licensed in 1981

5. Healthy People 2000 & 2010 Objectives for Hepatitis B Vaccination of High Risk Adults
Occupationally exposed—90%
Men who have sex with men—50%
IDUs—50%
2010
Occupationally exposed—98%
Men who have sex with men—60%
Long-term hemodialysis patients—90%

6. National Health Interview Survey (NHIS), 2000
Conducted by the National Center for Health Statistics, CDC
Continuous operation since 1957
Data collected through household face-to-face interviews of the U.S. resident civilian noninstitutionalized population
Primary source of general health information

7. NHIS Design – 1 Stratified multistage sampling
One sample adult and one sample child (if present) are interviewed in each family
Used SUDAAN 8.0 to analyze the weighted data.

8. NHIS Design – 2
All responses are self-reported and are not provider verified.
A respondent weight is assigned that adjusts for the probability of being sampled and for non-response to provide unbiased and design-based estimates of any U.S. target population.
Used SUDAAN 8.0 to analyze the weighted data.

9. Hepatitis B Vaccination Questions
Have you EVER received the hepatitis B vaccine?
Yes/No/Refused/Don’t know
If Yes: Did you receive at least 3 doses, or less than 3 doses?
Received at least 3 doses/Received less than 3 doses/Refused/Don’t know
Used SUDAAN 8.0 to analyze the weighted data.

10. Demographic Variables Included in this Analysis
Gender, age, race/ethnicity, education
Marital status, family income, family size
City size (MSA), census region
Health insurance

11. Lifestyle Variables Included in this Analysis – 1
Occupation, composite risk group*
Chances of getting HIV, ever tested for HIV, main reason for HIV test
STD, where checked for STD
Usual place of routine care type, medical record source (preventive vs sick care), time since last talked to a health professional & number of visits in past 12 months.
* Men who have sex with men, persons who ever traded sex for money or drugs, IVDUs, HIV positives, hemophiliacs who have received clotting factor concentrates, and their sex-partners.

12. Lifestyle Variables Included in this Analysis – 2
Lived with someone with hepatitis
Family hepatitis history
Lived with someone with liver cancer
Family liver cancer history
Smoking status, alcohol drinking status
Physical activity, BMI

13. Risk Status Strata Aged 18-64 Years n=26,194
Occupational risk n=1,714
Healthcare, police and fire
Behavioral risk (excluding above) n=1,460
Men who have sex with men, IVDUs, HIV positives, clotting factor recipients, traders of sex for money or drugs, and sex-partners; STD patients, and those reporting high or medium chance of getting HIV.
Possible risk (excluding above) n=8,703
Ever tested for HIV, ever lived with someone with hepatitis, or API
No identified risk n=14,317

14. Hepatitis B Vaccination by Risk Groups, Aged 18-64 Years, NHIS, 2000
Sample Size
Hepatitis B
Vaccination
Dose 1 Rates
% (95% CI)
Occupational
1,714
74 (71-76)
Behavioral
1,460
30 (27-33)
Possible
8,703
27 (26-28)
No Identified
14,317
16 (15-17)

16. Significant Associations Found

17. Hepatitis B Vaccination by Risk Status and Gender, Aged 18-64 Years, NHIS, 2000 (n=26,194)* * *
Male vs. Female p<0.05 *

18. Hepatitis B Vaccination by Risk Status and Age, Aged 18-64 Years, NHIS, 2000 (n=26,194)* * *
Age group vs y p<0.05 * *

19. Hepatitis B Vaccination by Risk Status & R/E, Aged 18-64 Years, NHIS, 2000 (n=26,194)*
R/E group vs. White p<0.05 * * * *

20. Hepatitis B Vaccination by Risk Status & Education, Aged 18-64 Years, NHIS, 2000 (n=26,194)* * * *
Group vs. <HS p<0.05 *

21. Hepatitis B Vaccination by Risk Status & Marital Status, Aged 18-64 Years, NHIS, 2000 (n=26,194)*
Group vs. Never married p<0.05 * * *

22. Hepatitis B Vaccination by Risk Status & Time Since Last Saw Provider, Aged Years, NHIS, 2000 (n=26,194)
95% CI * * * *
≤ 2 years vs.
2 years
p<0.05

23. Adults Less Likely to Receive Hepatitis B Vaccination
Males (except in behavior risk group)
Age 35+ (except in occupational risk group)
Whites vs. blacks in possible risk group
Hispanics & blacks vs. whites in occupational risk group
Educational level of less than high school
Never married (except in occupational risk group)
Not seen a provider in over 2 years (except in occupational risk group)
No HBV risk

24. Have Unvaccinated Adults at Risk for HBV Infection had the Opportunity for Protection?
Of 30,007 adults, 23,807 (79.3%) had not received hepatitis B vaccine.
Of these 23,807, 7881 (33.1%) had a risk factor.*
Of these 7881, 91.6% had talked to a provider in the last 24 months; 79.4% visited the MD in last 12 months, 62.4% times
* Health care, police or fire occupation; ever had a STD other than HIV; ever tested for HIV; high or medium chance of getting HIV; ever lived with someone with hepatitis or liver cancer; men who have sex with men, persons who ever traded sex for money or drugs, IVDUs, HIV positives, hemophiliacs who have received clotting factor concentrates, and those who have had sex with any in these groups.

25. Limitations – 1
NHIS 2000 does not directly measure progress toward HP 2000 and 2010 objectives for hepatitis B vaccination—among adults who are occupationally exposed, among men who have sex with men, IDU, or among chronic hemodialysis patients.

26. Limitations – 2 Non-validated data
We do not know the quality of recall information related to adult hepatitis B vaccination

27. Conclusions – 1
Hepatitis B vaccination rates among adults at risk for HBV infection are low.
Recent provider contact was associated with higher likelihood of vaccination.

28. Conclusions – 2
Adults at risk have seen providers in the past 24 months but rarely have utilized the opportunity to be vaccinated.
More specific data sources are needed to measure progress toward Healthy People objectives.

29. Recommendations – 1
Providers need to identify adults at risk for HBV infection (tools may be needed) and offer hepatitis B vaccination to them.
Health education and motivation to ensure hepatitis B vaccination as indicated should be provided to both adults at risk and their providers.

30. Recommendations – 2
Hepatitis B vaccine should be offered to all susceptible patients in STD, family planning, and drug treatment clinics, HIV prevention sites and correctional facilities.