Background: The most effective way to prevent hepatitis B virus (HBV) infection is vaccination. Synthesized data on vaccination coverage in adults against hepatitis B in China are scarce. We aimed to estimate the hepatitis B vaccination rate in adults in China. Methods: We searched PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, WanFang, and Sinomed databases for observational studies published between 1 January 2011 and 1 October 2021. Data were extracted using a standardized form to estimate the pooled vaccination coverage rate and 95% confidence intervals (CI) based on inclusion and exclusion criteria. Subgroup analysis was employed to explore heterogeneity. This study is registered in PROSPERO, CRD42021293175. Results: We identified 5128 records, of which 21 articles that included 34,6571 adults. The pooled coverage rate and 95% confidence intervals were 26.27% and 22.73–29.82%, respectively. The pooled coverage rates were 22.06% (95% CI: 15.35–28.78%), 33.81% (95% CI: 28.77–38.85%) and 23.50% (95% CI: 17.37–29.64%) in eastern China, central China and western China, respectively. Furthermore, males had a pooled hepatitis B vaccination coverage rate of 23.47% (95% CI: 15.61–31.33%), whereas, in females, the coverage rate was 26.60% (95% CI: 18.73–34.47%). The pooled hepatitis B vaccination coverage rate in the age group younger than 40 years was 36.93% (95% CI: 28.35–45.50%), while in the ≥40-year-old group, the pooled hepatitis B vaccination coverage rate was 17.09% (95% CI: 10.18–24.00%). The pooled hepatitis B vaccination coverage rate in urban areas (40.29%, 95% CI: 20.91–59.67%) was higher than in rural areas (16.54%, 95% CI: 7.80–25.29%). The average weighted, pooled hepatitis B vaccination coverage rate was 26.53% (20.25–32.81%) in 2011–2015 and 26.12% (22.04–30.20%) in 2016–2021. Conclusions: This systematic review provides the hepatitis B vaccination coverage rate of adults in China (26.27%). The low prevalence of vaccine-mediated immunity among adults in China underscores the urgent need for targeted immunization strategies for vulnerable Chinese adults to ensure progress toward the target of eliminating hepatitis B by 2030.

Hepatitis B vaccination coverage rates are low throughout most populations in China. Factors influencing low coverage rates, including population-specific hepatitis B vaccination barriers, may inform policies that promote vaccination. A cross-sectional survey of residents from 43 communities assessed their vaccination status and identified associated factors via uni- and multivariable logistic regression and subgroup analyses. In total, 11,280 of 36,007 respondents received a hepatitis B vaccine, indicating a 31.33% coverage rate. Multivariable logistic regression revealed non-Beijing (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.76–0.85) and residents who self-rated their health as very healthy (OR = 0.82; 95% CI: 0.68–0.99) were unlikely to be vaccinated. Farmers (OR = 1.68; 95% CI: 1.51–1.86), commerce and service workers (OR = 1.82; 95% CI, 1.63–2.04), government employees (OR = 1.56; 95% CI: 1.38–1.77), professionals and technicians (OR = 1.85; 95% CI: 1.63–2.09), and students (OR = 1.69; 95% CI: 1.10–2.59) had increased hepatitis B vaccination rates. The multivariable assessment revealed hepatitis B vaccination coverage rates are associated with confirmed or suspected family cases, vaccination unwillingness or uncertainty, and unawareness of its prevention of the hepatitis B virus. Low hepatitis B vaccination coverage rates among Beijing subpopulations highlight the need for improved strategies, including those that target specific populations.

Evidence on the effectiveness of hepatitis B virus (HBV) infection screening and vaccination programs remains rare in China. We used a quasi-experimental method, propensity score matching, to evaluate the effects of a community-based HBV infection detection combined with vaccination (HBVIDV) program in a pilot. Data were retrieved from the HBVIDV program implemented between July 2019 and June 2020. Outcomes were the difference between the treatment and control groups in hepatitis B vaccination (≥1 dose), hepatitis B vaccine series completion (≥3 doses), and serologic evidence of vaccine-mediated immunity. Altogether, 26,180 individuals were included, where 6160 (23.5%) individuals were assigned to the treatment group, and 20,020 (76.5%) individuals were assigned to the control group. After propensity score matching, 5793 individuals were matched. The rates of hepatitis B vaccination, hepatitis B vaccine series completion, and prevalence of vaccine-mediated immunity in the treatment and control groups were 29.0% vs. 17.8%, 22.1% vs. 13.1%, and 38.2% vs. 27.6%, respectively. The HBVIDV program was significantly associated with increased hepatitis B vaccination rate (OR, 1.884, 95% CI 1.725–2.057), hepatitis B vaccine series completion rate (OR, 1.872, 95% CI 1.696–2.065), and prevalence of vaccine-mediated immunity (OR, 1.623, 95% CI 1.501–1.755). The greater magnitude of association between HBVIDV program and outcomes was observed among adults aged 35–54 years and adults who live in rural areas. The HBVIDV program was effective in increasing the hepatitis B vaccination rate, hepatitis B vaccine series completion rate, and prevalence of vaccine-mediated immunity among adults in the pilot. Further focusing the program on special populations and regions may produce more effective results.