Lack of compliance with hepatitis B vaccination among Canadian STD clinic patients: candidates for an accelerated immunization schedule?

Compliance with hepatitis B vaccination among adult males with sexually transmitted infections

Background:

Sexually transmitted infections (STIs) are a diverse group of infections caused by widely differing microorganisms (viruses, protozoa, bacteria, yeasts, ectoparasites and even a nematode), with transmission from person to person by sexual contact as its common characteristic. In all societies, sexually transmitted infections rank among the most common infectious diseases. These patients are at risk for hepatitis B virus infection, but have been relatively neglected in terms of hepatitis B virus vaccination.

Objectives:

In this study, compliance with hepatitis B vaccination among adult males with sexually diseases was examined.

Patients and Methods:

In this survey, 114 males, referred to an infectious diseases clinic, were asked to complete a questionnaire evaluating their knowledge of hepatitis B vaccine, and were interviewed to assess their reasons for refusal or acceptance. Finally, SPSS (version 16) was used to perform the statistical analyses. Variables were analyzed with Chi-square tests.

Results:

The results of this study indicated that the overall hepatitis B vaccine acceptance rate was acceptably high. Among all, 53.5% correctly identified that a vaccine to prevent hepatitis B virus infection had been available, 15% had a negative opinion, and 31.5% were neutral. The rations of all three doses of vaccination were 69.3%.

Conclusions:

Among the respondents, 87% were currently married, 86.8% were currently employed, 17.5% have addiction, 34.2 % used condom, and 36.8% correctly identified hepatitis B as a sexually transmitted infection.

A/H1N1 vaccine intentions in college students: an application of the theory of planned behavior

OBJECTIVE

To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine.

PARTICIPANTS

Undergraduate communication students at a metropolitan southern university.

METHODS

In January-March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N=198; 70% Caucasian).

RESULTS

The TPB model explained 51.7% (p<.001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block.

CONCLUSIONS

For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.

Tattooing and risk of hepatitis B: a systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis is to assess the association between tattooing and the risk of transmission of hepatitis B virus.

METHODS

A systematic search of MEDLINE, EMBASE, PubMed, Database of Abstracts of Reviews of Effects, ACP Journal Club and BIOSIS Previews was performed up to March 2011.

RESULTS

Forty-two observational studies were included in this systematic review, of which 31 were included in the meta-analysis. Pooled odds ratios (95% confidence intervals) of the association of tattooing and hepatitis B infection was 1.48 (1.30-1.68) when all studies were included in the analysis. Subgroup analysis shows the strongest association between tattooing and risk of hepatitis B among populations involved in high-risk behaviours (OR = 1.64, 95% CI: 1.32-2.03).

CONCLUSION

Findings of the current systematic review and meta-analysis indicate that tattooing is associated with hepatitis B transmission in all subgroups. A population health approach that emphasizes universal hepatitis B immunization, education of young adults who are more likely to get tattoos, and education of prison inmates (who have the highest background rate of hepatitis B infection), along with enforcement of guidelines and safer tattooing practices in prison, are fundamental in prevention of transmission of hepatitis B.

Predictors of first and second dose acceptance of hepatitis B vaccine among STD clinic patients

Our goal was to identify attitudinal, behavioural and pragmatic factors predictive of receipt of the first and second doses of hepatitis B virus (HBV) vaccine. In this study, 431 adult sexually transmitted disease clinic patients with no reported history of prior HBV vaccination or infection completed a computer-assisted questionnaire, then were offered free HBV vaccine. Those who accepted were scheduled for follow-up doses. Twenty-nine percent received the first dose of vaccine. Of these individuals, 21% returned for the second dose. Seven participants received all three doses. Health beliefs and caring for three or more children predicted first dose acceptance. Less travel time to the clinic and caring for two or fewer children predicted return for the second dose. HBV vaccination rates were low in this study. Interventions designed to modify health beliefs may increase first dose uptake. Increases in receipt of subsequent vaccine doses might best be accomplished through approaches designed to decrease pragmatic barriers to vaccine access.

Hepatitis B Infection and Vaccination Among High-Risk Noninjection Drug-Using Women: Baseline Data From the UNITY Study

OBJECTIVES

Few studies of hepatitis B virus (HBV) infection and hepatitis B vaccination have focused on women, and specifically, women who are at high risk. This study was designed to assess the extent of HBV infection and vaccination, level of knowledge about hepatitis B, motivators and barriers to accepting vaccination and uptake of hepatitis B vaccine.

DESIGN

From March 2005 to June 2006, 402 HIV-negative noninjection drug-using women at sexual risk were recruited, interviewed, and tested for markers of HBV infection.

RESULTS

Based on serologic testing, 16.7% were previously vaccinated against HBV, 31.1% were previously infected and 52.2% were still susceptible to HBV. Knowledge of HBV infection, transmission, and prevention was low with a mean of 6.1 of 12 knowledge items correctly identified as true or false; a substantial percent of women were not sure of the correct answer. Of the women still susceptible, 69.0% started the hepatitis B vaccine series after counseling given through the study.

CONCLUSION

This study illustrates that there continues to be gaps in current strategies for administering hepatitis B vaccine among female populations at sexual risk. Interventions are needed for this population to increase awareness and knowledge of hepatitis B, its transmission, impact on health and the availability of a safe and effective vaccine, supplemented by community programs for adult vaccination.

Acceptance of hepatitis B vaccination among adult patients with sexually transmitted diseases

BACKGROUND

Sexually transmitted disease (STD) clinic patients are at risk for hepatitis B virus infection, but have been relatively neglected in terms of hepatitis B virus (HBV) immunization. Acceptance of HBV vaccine among patients attending an STD clinic was examined.

GOAL

To evaluate potential predictors of HBV vaccine acceptance.

STUDY DESIGN

In this study, 99 patients attending an STD clinic completed a brief questionnaire that addressed knowledge of STD and vaccines as well as sexual behavior. After the questionnaire, each patient was offered HBV vaccine, then interviewed to assess reasons for acceptance or refusal.

RESULTS

Among the patients in this study, 23% accepted the vaccine and 11% reported prior vaccination. Acceptors were younger, had less education, and used condoms less frequently than those who refused vaccination. The reasons given for acceptance or rejection typically involved health beliefs related to infection or vaccination.

CONCLUSION

The findings indicate an unacceptably low rate of HBV vaccine acceptance in a group at high risk for infection. However, some of the reasons for refusal may be modifiable through brief, targeted interventions.

Predictors of positivity for hepatitis B and the derivation of a selective screening rule in a Canadian sexually transmitted disease clinic

OBJECTIVES

To determine the prevalence of hepatitis B surface antibody (anti-HBs) and antigenemia (HBsAg), the risk factors for seropositivity and the effectiveness of a selective serologic screening rule among sexually transmitted diseases (STD) clinic attendees.

STUDY DESIGN

Clients in the Hamilton STD Clinic were surveyed from October 1992 to July 1993 on sociodemographic, past medical, and behavioural data, were tested for several STDs and were offered serological testing and vaccination against hepatitis B. Predictors of seropositivity were determined by single variable analysis. A selective serologic screening rule was derived using logistic regression modelling.

RESULTS

The seroprevalence of anti-HBs was 6.8% (21/310) in the 310 of 385 clients (80.5%) who agreed to be tested and interviewed. There were no HBsAg carriers. Five independent risk factors were identified by logistic regression: (1) age greater than 35 years; (2) birth outside Canada and histories of; (3) syphilis; (4) gonorrhoea; or (5) injection drug use. If clients with at least one of these predictors had been tested, 34.5% would have been selected for serologic testing and 85.7% of all positives would have been detected. The screening rule was more effective for men than for women.

CONCLUSION

In this low prevalence setting, selecting STD clinic clients based on the presence of any one of five risk predictors appears to be an effective strategy for hepatitis B serologic screening in the context of a Canadian vaccination program.