Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7037
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
Testing campaigns for hepatitis B virus (HBV) have often focused on identifying infected patients [i.e. those with hepatitis B surface antigen (HBsAg)-positive serology] and increasing disease-status awareness. Few evaluations have been performed on how testing campaigns can impact vaccination uptake after receiving non-immunized status.
Since France has a low proportion of vaccinated individuals compared to other Western countries, interventions to increase HBV vaccination rates need to be evaluated in this population. This analysis addressed vaccination initiation among non-immunized participants in a large-scale screening campaign within the Paris metropolitan region. These individuals reflect a wide range of groups at-risk of HBV infection, allowing potential identification of subgroups with low vaccination coverage.
We aimed to describe rates of vaccination among non-immunized individuals during a mass-screening program. We also intended to evaluate the reasons for not initiating HBV vaccination after testing. This allows a first-hand account of why individuals do not vaccinate and helps tailor the needs for future intervention campaigns.
Participants were recruited from two large phases of a multi-center, HBV-testing campaign in Paris, France. Non-immunized subjects were identified and contacted via telephone 3-9 mo after testing in order to determine whether they initiated vaccination. We considered vaccination coverage of all respondents (in a per-protocol analysis) and the overall non-immunized study population while assuming no vaccination in non-responders (in an intent-to-treat analysis).
Overall vaccination uptake was low with 11% of respondents declaring HBV vaccination initiation within 3-6 mo of testing. Few risk-factors for increased vaccination initiation were identified: from moderate or high HBV-endemic countries, with limited healthcare coverage, and men who have sex with men. Compelling differences were observed between centers with vaccination coverage ranging from 0%-56%.
Given the low vaccine uptake in individuals at potential risk of HBV-infection, there is a major concern in the cascade of care among non-immunized individuals. The contrasting vaccination rates between centers indicate that the challenge to increase vaccination initiation lies within center-specific practices. At the individual level, increasing motivation to vaccinate among physicians and non-immunized persons alike should be stressed.