Hepatitis B markers in heterosexual patients attending two genitourinary medicine clinics in the West Midlands.

El-Dalil, A A; Jayaweera, Dushyantha; Walzman, M; Radcliffe, K W; Richmond, R.; Wade, A; Shahmanesh, M

doi:10.1136/sti.73.2.127

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…The prevalence in t 1 was similar to the 15.3% for British MSM recruited via outreach activities [24]. In HRPs, the anti-HBc prevalence was with 5.5% (t 1 ) and 4.5% (t 2 ), higher than the 0.8%-3.2% reported in heterosexual STI clinics visitors in other lowendemic countries [25,26]. This is in line with the high participation of ''swingers" in the HRPs, of whom it is known that they have a high STI prevalence [27].…”

Section: Discussionmentioning

confidence: 84%

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

Mangen

Stibbe

Urbanus

et al. 2017

Vaccine

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a b s t r a c tBackground: The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. Methods: Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002-2006 and 2007-2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections -as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. Results: The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. Discussion and conclusion: This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per riskgroup, increase effects or when to integrate the vaccination in regular healthcare.

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Section: Discussionmentioning

confidence: 84%

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

Mangen

Stibbe

Urbanus

et al. 2017

Vaccine

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“…This should be confirmed by studies that determine the country of birth and other risk factors of each individual. A study of heterosexual GUM clinic attenders in the West Midlands found a prevalence of past infection of 1n9 %, with most (15\28) positives born outside the UK [24]. Similar studies elsewhere would provide an upper limit on the risk of heterosexual infection in England and Wales.…”

Section: Discussionmentioning

confidence: 93%

The prevalence of hepatitis B infection in adults in England and Wales

Hesketh

Osborne²,

Farrington³

et al. 1999

Epidemiol. Infect.

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Cost effectiveness analyses of alternative hepatitis B vaccination programmes in England and Wales require a robust estimate of the lifetime risk of carriage. To this end, we report the prevalence of infection in 3781 anonymized individuals aged 15-44 years whose sera were submitted in 1996 to 16 microbiology laboratories in England and Wales. One hundred and forty-six individuals (3.9%) were confirmed as anti HBc positive, including 14 chronic carriers (0.37%). The prevalence of infection and carriage was higher in samples collected in London and increased with age. No increased risk of infection was seen in sera from genito-urinary (GUM) clinics. Only 15 sera positive for hepatitis B were also positive for hepatitis C. Our results confirm the low prevalence of hepatitis B in England and Wales, are consistent with previous estimates of carriage and suggest that many infections were acquired while resident outside the UK. Future prevalence studies should determine the country of birth and other risk factors for each individual in order to confirm these findings.

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“…Enhanced surveillance has suggested that obtaining more complete data would attribute a higher proportion of cases to sexual exposure [3], and therefore this increase may represent better recognition and reporting of this route of transmission. A survey amongst homosexuals in clinic and community settings found that 17 % had evidence of past HBV infection [26], whereas the prevalence of past infection was low in heterosexuals attending a GUM clinic outside of London [27]. National coverage of selective vaccination has not been determined but ad-hoc surveys suggest that coverage in GUM clinics is low [23,28,29].…”

Section: Discussionmentioning

confidence: 99%

Acute hepatitis B infection in England and Wales: 1985–96

Balogun¹,

Ramsay²,

Fairley

et al. 1999

Epidemiol. Infect.

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Confirmed acute hepatitis B infections are reported to the Public Health Laboratory Service Communicable Disease Surveillance Centre by laboratories in England and Wales. These reports have been used to monitor trends in the incidence of hepatitis B virus (HBV) infection over time, and between exposure categories and age groups. Between 1985 and 1996 a total of 9252 cases of acute HBV infection were reported; the number of reports fell from 1761 in 1985 to 581 in 1996. Most infections were reported in adults aged 15-44 years [n = 7365 (80%)], and infections were more commonly reported in males [n = 6490 (70%)] than females [n = 2658 (29%)]. The probable means of acquisition was known for just over half of all adult cases [4827/8956 (54%)]. Injecting drug use was the most common exposure [n = 1901 (21%)], followed by sex between men and women [n = 1140 (13%)] and sex between men [n = 1025 (11%)]. The number of infections in injecting drug users fell in the late 1980s, but increased again from 1991 onwards. In children aged under 15 years, infections acquired by mother to baby transmission accounted for 35/170 (21%) of the total. Surveillance indicates that the incidence of acute hepatitis B infection fell in the late 1980s, probably reflecting changed behaviour in injecting drug users. An increase in the number of infections in injecting drug users since 1993 may indicate ongoing transmission that has not been contained by the introduction of needle exchange schemes or by selective vaccination.

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Hepatitis B markers in heterosexual patients attending two genitourinary medicine clinics in the West Midlands.

Abstract: Objective: To determine the prevalence of hepatitis B virus (HBV) infection in heterosexual patients attending two genitourinary medicine (GUM)

Cited by 7 publications

References 13 publications

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

The prevalence of hepatitis B infection in adults in England and Wales

Acute hepatitis B infection in England and Wales: 1985–96

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