Travel-related hepatitis B: risk factors and prevention using an accelerated vaccination schedule

Hepatitis B Vaccination Status among Japanese Travelers

This study clarified the characteristics of travelers who received hepatitis B vaccinations. Subjects were 233 Japanese travelers who visited our clinic prior to travel. We summarized the characteristics of the clients and performed two comparative studies: first, we compared a hepatitis B-vaccinated group with an unvaccinated group; second, we compared a group that had completed the hepatitis B vaccine series with a group that did not complete the series. The hepatitis B vaccine was administered to 152 clients. Factors positively associated with the hepatitis B vaccination (after adjusting for age and sex) included the following: travel for business or travel as an accompanying family member; travel to Asia; travel for a duration of a month or more; and, inclusion of the vaccine in a company or organization's payment plan. Meanwhile, factors negatively associated with the vaccination were travel for leisure or education, and travel to North America or Africa. Among 89 record-confirmed cases, only 53 completed 3 doses. The completion rate was negatively associated with the scheduled duration of travel if it was from a month to less than a year (after adjusting for age and sex). The present study provides a basis for promoting vaccination compliance more vigorously among Japanese adults.

Epidemiology of hepatitis B virus infection: results from a community-based study of 0.15 million residents in South China

Limited information is available about the current epidemic status of hepatitis B virus (HBV) in Guangdong province in South China, where hepatitis B is endemic. We sought to provide an up-to-date assessment of hepatitis B prevalence in a large population through a community-based study. A total of 169,211 local residents were recruited using the stratified cluster random sampling method from 2014 to 2015, and each participant's information was collected using an interviewer-administered questionnaire. Accordingly, the prevalence of hepatitis B surface antigen (HBsAg) in the total population was 8.76%. HBsAg prevalence was lowest (0.29%) among children aged 0-12 years and highest (12.71%) among those aged 23-59 years. Moreover, the prevalence (8.82%) in males approximately equalled that (8.65%) in females (P > 0.05). Overall, vaccination was effective in preventing HBV infection, regardless of age. Among adults aged 23-59 years, male sex tended to keep the HBsAg persistence. However, reduced persistence for participants with occasional physical exercise and drinking was observed. For participants older than 59 years, a history of prior surgery placed people at high risk for infection. Although Guangdong has successfully decreased the HBsAg prevalence among children, it is urgent to expand vaccination to adults, and employ interventions to reduce the infection risk.

Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†

BACKGROUND

Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries.

METHODS

An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18-65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed.

RESULTS

Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses.

CONCLUSIONS

HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller awareness and adherence to vaccination schedules.

Summary of recommendations for the prevention of viral hepatitis during travel

Viral hepatitis is considered the most common travel-related, vaccine-preventable disease. All non-immune travellers to developing countries should consider vaccination with inactivated Hepatitis A (HA) virus vaccine and recombinant Hepatitis B (HB) virus vaccine. Inactivated HA and recombinant HB vaccines are safe, have few side effects and are effective in providing long-lasting protection. All monovalent HA and HB vaccines available for use within Canada are equally effective, and each can be used interchangeably. HA Ig (immune globulin) should be used to prevent HA only in those for whom active HA vaccines are contraindicated, in immunocompromised individuals who may not respond adequately to the active vaccines or in infants less than one year of age. All travellers should practise routine protective measures when abroad. HB virus carriers travelling to Hepatitis D virus-endemic countries should be particularly vigilant in avoiding high-risk activities such as skin piercing and unsafe sexual practices.

A case-control study of risk factors for hepatitis B virus infection in North Jordan

Jordan is a country with intermediate endemicity for hepatitis B virus (HBV) infection where risk factors for viral transmission and their relative contributions are not well known. A case-control study of 100 hepatitis B virus seropositive patients and another 100 seronegative controls was conducted. Univariate analysis and logistic regression model were performed to examine probable risk factors for acquisition of hepatitis B virus infections. Logistic-regression analysis showed that significant risk factors for acquisition of hepatitis B virus infection were sharing toothbrushes (odds ratio = 10.167; 95% confidence interval, 1.181-87.509), unhygienic dental care (odds ratio = 2.455; 95% confidence interval, 1.294-4.658), and living abroad for at least 1 year (odds ratio = 20.018; 95% confidence interval, 2.268-176.685). The presence of these risk factors emphasizes the need for both increasing the use of hepatitis B vaccines and risk-targeted public health education. Development and enforcement of appropriate infection control guidelines for dental care services are also necessary to curtail HBV transmission. Further research that controls for confounding factors is needed to assess the relative contribution of the identified risk factors in the Jordanian community.

Combined hepatitis A and B vaccine: providing a bright future for preventing hepatitis

The first combined hepatitis A and B vaccine has been available in the United States since 2001. The vaccine provides protection against viral hepatitis with rapid seroprotection and lasting immunogenicity. This review outlines the product's components, clinical efficacy and opportunities for use in special circumstances. The vaccine has a good safety profile and has good tolerability. The combined hepatitis A and B vaccine is a well studied vaccine that provides rapid seroconversion with a good safety profile.

The underestimated risk of hepatitis A and hepatitis B: benefits of an accelerated vaccination schedule

Hepatitis A virus (HAV) and hepatitis B virus (HBV) are vaccine-preventable. Current recommendations advocate vaccination of non-immune adults at risk of exposure, including travelers to HAV or HBV endemic areas, individuals with high risk of contracting a sexually transmitted infection, and some correctional facility inmates. We review the use of an accelerated schedule to administer the combination hepatitis A and hepatitis B vaccine (Twinrix). Administering three doses over three weeks and a fourth at 12 months provides rapid initial protection of most individuals for whom the standard 6-month vaccination schedule would not be suitable, including last-minute travelers and short-term correctional facility inmates. Furthermore, we consider the role of a universal vaccination strategy in preventing the spread of HAV and HBV.

Schedules for hepatitis B vaccination of risk groups: balancing immunogenicity and compliance

INTRODUCTION

Vaccination is an important tool in hepatitis B prevention. However, several vaccine doses are required to induce long-term protection. Several at-risk groups have difficulties in adhering to the standard vaccination schedule.

OBJECTIVES

This paper aims to review the use of accelerated hepatitis B vaccination schedules, in terms of immunogenicity and compliance.

RESULTS

Accelerated schedules (0.1.2.12 months) or super-accelerated schedules (0.7.21.360 days) have been shown to result in higher proportions of healthy vaccinees reaching anti-HBs antibody levels >or=10 IU/l more rapidly. A fourth completing dose is required to lift antibody levels to an equal height, as does a standard (0.1.6 months) schedule. Accelerated schedules do also increase the uptake of hepatitis B vaccine, that is the proportion of vaccinees who receive three doses. However, completing the schedule with a fourth dose is usually more difficult than completing a standard 0.1.6-month schedule. Several additional tools can help to increase the compliance (eg, reminder systems, outreach services and incentive schemes).

CONCLUSION

For rapid seroconversion and almost immediate protection in the short term, a (super)accelerated schedule could be used in at-risk groups. As long-term protection data with these (super) accelerated schedules have not been documented yet, a fourth dose at month 12 is still required. A shortened schedule (0.1.4 months) might be an alternative worth considering compared with the standard 0.1.6, as it convenes to internationally accepted minimum dose intervals and offers earlier protection. There is a clear need to study the long-term protection and effectiveness of the primary part of (super)accelerated schedules.

Sexual health and HIV in travellers and expatriates

Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.

Rapid and sustained immune response against hepatitis A and B achieved with combined vaccine using an accelerated administration schedule

BACKGROUND

Combined hepatitis A and B vaccine administered on an accelerated schedule provides a rapid immune response against both hepatitis A and B viruses, which might be especially relevant for individuals who need protection quickly.

METHODS

A prospective, open-label, randomized study to compare the immunogenicity and reactogenicity of the combined hepatitis A and B vaccine Twinrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) (>or=720 EL.U/mL inactivated hepatitis A antigen and 20 microg/mL recombinant hepatitis B surface antigen [HBsAg]) administered at 0, 7, 21 to 30 days, and 12 months compared with concurrent administration of Havrix [GlaxoSmithKline Biologicals, Rixensart, Belgium (>or=1440 EL.U/mL inactivated hepatitis A antigen)] at 0 and 12 months, and Engerix-B [GlaxoSmithKline Biologicals, Rixensart, Belgium (20 microg/mL recombinant HBsAg)] at 0, 1, 2, and 12 months in seronegative healthy adults.

RESULTS

At month 13, the anti-hepatitis B seroprotection rates (>10 mIU/mL) for the combined vaccine compared to the monovalent hepatitis B vaccine were 96.4% (95% CI: 92.7-98.5) and 93.4% (95% CI: 89.0-96.4), respectively. The anti-hepatitis A seroconversion rates were 100% in both groups (95% CI: 98.1-100). At day 37, the anti-hepatitis A seroconversion rates were similar in both groups (98.5% for combined vaccine, 98.6% for the monovalent vaccine group), but the combined vaccine resulted in a statistically significantly ( p < 0.001) better anti-hepatitis B seroprotection compared to monovalent hepatitis B vaccine, 63.2% versus 43.5%, respectively. The reactogenicity profile was similar in both study groups.

CONCLUSIONS

The combined hepatitis A and B vaccine administered on an accelerated schedule was at least as immunogenic and as well tolerated as the corresponding monovalent vaccines.

Risk of exposure to hepatitis B and other blood-borne viruses among Australians who travel abroad

BACKGROUND

European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure.

METHOD

A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition.

RESULTS

In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B.

CONCLUSIONS

The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.