Progressive decrease of hepatitis B in a cohort of drug users followed over a period of 15 years: The impact of anti-HBV vaccination

Abstract

In the Western world, the population at the highest risk of HBV infection is probably that of illicit drug users (DUs). Since 1985, 1 Public Health Centre for Drug Users (PHCDU), in north-eastern Italy, has been asking all heroin DUs, whether in treatment or not, to undergo screening for HIV, HBV and, since 1989, for HCV infection. Since 1988 the Centre has proposed HBV vaccination to all patients who were negative for all HBV markers. From 1985 to 2001 895 heroin DUs were screened, 726 males and 169 females. 442 (49.4%) were negative to HBV markers at the first control and 72.4% received at least 1 dose of the vaccine. 320 DUs were vaccinated and a total of 995 doses of recombinant vaccine were administered. The anti-HBc antibody appeared in 2 vaccinated patients out of 258 DUs undergoing controls, while 13 seroconversions for anti-HBc occurred in 45 DUs who had refused to be vaccinated. On the basis of these results, HBV vaccination of DUs can be strongly recommended. Vaccination showed a good adherence in a population difficult to treat and can have a leading role in reducing HBV infection in DUs and their contacts.

Hepatitis B virus exposure and vaccination in a cohort of people who inject drugs: What has been the impact of targeted free vaccination?

“…These programs commenced in Victoria, Australia's second most populous state, in 1998 and 2001, respectively, and their impact on PWID vaccination coverage and incident HBV infection has not been examined. In the USA and Europe, evidence of the impact of universal and/or targeted HBV vaccination policies is mixed …”

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

“…Based on Williams et al [16], we assumed vaccine effectiveness (VE) of 90%, 70% and 40% for three, two and one vaccine dose, respectively. Furthermore, we assumed that protection would last life-long [16,17]. The difference between the two scenarios serves as our estimate of then the number of avoided hepatitis B infections.…”

Drug Users' Participation in a Free Hepatitis B Vaccination Program: Demographic, Behavioral, and Social-Cognitive Determinants

“…Lugoboni et al (2004) showed that in Italy 88% of 320 DUs had received three or more vaccinations; however, in that cohort study, participants were studied over 15 years, and were followed up every 4 months. The extensive screening and the longer period that free vaccination was available in that study may explain the higher compliance among Italian DUs.…”

“…Previous studies among DUs have reported completion rates of hepatitis B vaccination, varying from low completion rates (20%-31%;Des Jarlais et al, 2001;Christensen et al, 2004;Seal et al, 2003), to intermediate (41%-63%; Christensen et al, 2004;Lum et al, 2003;Ompad et al, 2004;McGregor, Marks, Hayward, Bell, and Slack, 2003;Van Houdt et al, 2006;Van Steenbergen, 2002), to high-compliance rates (66%-88%; Altice, Bruce, Walton, and Buitrago, 2005;Budd, Robertson, and Elton, 2004;Christensen et al, 2004;Des Jarlais et al, 2001;Lugoboni et al, 2004;Rogers and Lubman, 2005;Seal et al, 2003;Quaglio et al, 2002) depending on the use of different vaccination schedules, onsite vaccination possibilities, and the use of monetary incentives. However, only some of these studies identified social-demographic factors (age, ethnic background, and homelessness), and risk factors concerning drug use (i.e., injecting drug use) associated with vaccine completion (Altice et al, 2005;Lum et al, 2003;Ompad et al, 2004, Seal et al, 2003.…”