Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 7037-7046
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7037
Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons
Anders Boyd, Julie Bottero, Fabrice Carrat, Joël Gozlan, Hayette Rougier, Pierre-Marie Girard, Karine Lacombe
Anders Boyd, Julie Bottero, Fabrice Carrat, Pierre-Marie Girard, Karine Lacombe, Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
Julie Bottero, Hayette Rougier, Pierre-Marie Girard, Karine Lacombe, Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
Fabrice Carrat, Département de santé publique, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
Joël Gozlan, Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
Joël Gozlan, INSERM, UMR_S1135 CIMI, Paris F-75013, France
Author contributions: Bottero J, Boyd A, Carrat F and Lacombe K conceived and designed the study; Bottero J and Rougier H conducted the study and ensured data quality; Gozlan J validated serological and virological results; Boyd A analyzed the data; Boyd A and Bottero J drafted the initial version of the paper; Carrat F, Gozlan J, Rougier H, Girard PM and Lacombe K gave critical revisions to the manuscript. All authors approved the final version of the manuscript.
Supported by the ANRS (Agence Nationale de Recherche contre le Sida et les Hépatites) and Mairie de Paris, No. 2010-334. Other unrestricted grants were received by Gilead Sciences and Roche. A post-doctoral fellowship from the ANRS and SIDACTION was awarded to A.B. for some of the work presented in this manuscript.
Institutional review board statement: The study was approved by the Hôtel-Dieu Hospital Ethics Committee (Paris, France) in accordance with the Helsinki Declaration.
Clinical trial registration statement:, no. NCT01767597.
Informed consent statement: Signed written informed consent was obtained for all eligible participants.
Conflict-of-interest statement: The authors report no conflicts of interest relevant to the manuscript.
Data sharing statement: The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. The data cannot be publicly available due to legal and ethical restrictions from the French Authority (Commission nationale de l’informatique et des libertés). Requests for data use can be made to the Scientific Manager of the study (Anders Boyd) at anders.boyd@
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Julie Bottero, MD, PhD, INSERM, UMR_S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, 184 rue du faubourg St Antoine, F-75012 Paris, France.
Telephone: +33-1-71970424 Fax: +33-1-49282595
Received: August 7, 2017
Peer-review started: August 8, 2017
First decision: August 31, 2017
Revised: September 11, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 14, 2017

To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.


Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).


In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries (P < 0.001), patients with limited healthcare coverage (P = 0.01) and men who have sex with men (P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was “will be vaccinated later” (33.4%), followed by “did not want to vaccinate” (29.8%), and “vaccination was not proposed by the physician” (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.


HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.

Keywords: Health service organization, Hepatitis B virus vaccination, Public health, Testing intervention, Vaccine coverage

Core tip: Testing for hepatitis B virus (HBV) not only serves as a means to identify HBV-infected individuals, but also those who are non-immunized and could further benefit from HBV vaccination. In this mass HBV-screening study within the Paris metropolitan region, vaccine uptake was achieved in 11% of non-immunized patients and was deemed poor. Strategies to increase vaccination after testing need to be considered.