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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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).

Research results

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%.

Research conclusions

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.