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November 2002, Vol 92, No. 11 | American Journal of Public Health 1756
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Hepatitis B Vaccination Among Research Participants, Seattle, Washington

Holly Hagan, MPH, PhD, Hanne Thiede, DVM, MPH, James P. McGough, PhD, MPH and E. Russell Alexander, MD

The authors are with Public Health—Seattle and King County, Seattle, Wash. Holly Hagan, Hanne Thiede, and E. Russell Alexander are also with the University of Washington School of Public Health and Community Medicine, Seattle.

Correspondence: Requests for reprints should be sent to Holly Hagan, MPH, PhD, Public Health—Seattle and King County, 106 Prefontaine Pl S, Seattle, WA 98104 (e-mail: hagan{at}ndri.org).


   INTRODUCTION
TOP
 INTRODUCTION
References
 
We report here on a protocol to increase hepatitis B virus (HBV) vaccination in participants in 2 research studies in Seattle, Wash. Injection drug users (IDUs) in a cohort study were interviewed and screened for several bloodborne viral infections, including HBV.1 At posttest counseling, participants were informed of their test results, provided risk reduction counseling, and referred to medical services. Prevalence of core antibody to HBV (anti-HBc) was 67%, and only 14% of the participants reported prior HBV vaccination.2 Participants who were anti-HBc negative were given a voucher for a no-cost series of HBV vaccinations redeemable at a public health clinic in downtown Seattle. The clinic agreed to accept people with vouchers on a drop-in basis, reduce waiting time, and record the number of vouchers redeemed. Between February and December 1997, 120 vouchers were distributed. Of participants with vouchers, 91 (76%) did not complete any vaccinations; 6 (5%) completed 1 vaccination and 5 (4%) completed 2. Only 18 IDUs (15%) completed the series of 3 HBV vaccinations.

A similar HBV vaccination protocol was implemented for a study of men aged 15 to 22 years attending Seattle same-sex venues (the Young Men’s Survey [YMS]).3 YMS participants received counseling and testing for HIV and HBV; 32% were HBV surface-antibody positive and 5% were anti-HBc positive.4 At the posttest visit, HBV-susceptible participants were counseled and given a voucher for free vaccinations at a health department clinic. Clinic staff agreed to record when the first voucher was redeemed but could not track subsequent vaccinations. In 1998, of 285 YMS participants offered vouchers, only 9 (3%) initiated vaccination.

Only a small proportion of participants in these 2 studies initiated or completed free HBV vaccinations offered off-site. One other study has reported on efforts to improve vaccination in research subjects. In a study of IDUs in Anchorage, Alaska, a $10 incentive increased completion of the first HBV vaccination at off-site locations from 7% to 48%.5 This preincentive rate of 7% compares with 24% completion of the first vaccination in our IDU study and 3% in the YMS. On-site vaccinations have been associated with higher completion rates at needle exchanges, drug treatment centers, and HIV counseling and testing programs,6–9 but research field offices may not be able to provide this service unless medically licensed personnel are present to administer vaccinations. Previous studies have also reported frequent missed opportunities for vaccination of IDUs and men who have sex with men in health care settings.10–14

HBV screening of participants in research studies may contribute to HBV prevention if it raises awareness of the need for vaccination in research participants and identifies gaps in local public and private health services. Our findings did contribute to the decision to assign a public health nurse to provide on-site vaccination at the Seattle needle exchange, and they were used in development of a local vaccination campaign for gay men. Thus it seems that HBV screening and referral to no-cost vaccinations provided by research studies may not, alone, serve to achieve acceptable vaccination levels. Additional strategies (which may include monetary incentives) are needed.


   Acknowledgments
 
Human Participant Protection
The study was approved by the institutional review boards of the University of Washington and the Washington State Department of Health.


   Footnotes
 
H. H. Hagan, H. Thiede, J. P. McGough and E. R. Alexander designed the study and worked on all drafts of the paper.

Peer Reviewed

Accepted for publication December 16, 2001.


   References
TOP
 INTRODUCTION
 References
 
1. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe exchange and risk of HBV and HCV in Seattle IDUs. Am J Epidemol. 1999;149:203–213.[Abstract/Free Full Text]

2. Thiede H, Hagan H, Murrill CS. Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health. 2000;77:331–345.[Medline]

3. Valleroy LA, MacKellar DA, Karon JM, et al. HIV prevalence and associated risks in young men who have sex with men. JAMA. 2000;284:198–204.[Abstract/Free Full Text]

4. Diamond C, Thiede H, Perdue T, Corey L. Seroepidemiology of viral hepatitis in young men who have sex with men. In: Proceedings of the 37th Annual Meeting of the Infectious Diseases Society of America; November 1999; Philadelphia, Pa.

5. Trubatch BN, Fisher DG, Cagle H, Fenaughty AM. Vaccination strategies for targeted and difficult-toaccess groups. Am J Public Health. 2000;90:447.[Free Full Text]

6. Mezzelani P, Venturini L, Turrina G, Lugoboni F, Des Jarlais DC. High compliance with a hepatitis B vaccination program among intravenous drug users. J Infect Dis. 1991;163:923.

7. Lugoboni F, Miglioi S, Sheisari F, et al. Immunoresponse to hepatitis B vaccination and adherence campaign among injecting drug users. Vaccine. 1997;15:1014–1016.[Medline]

8. Des Jarlais DC, Fisher DG, Newman JC, Trutbach BN, Yancovitz M, Paone D, Perlman Dl. Providing hepatitis B vaccination to injection drug users: Referral to health clinics vs. on-site vaccinations at a syringe exchange program. Am J Public Health 2001; 91: 1791–1792.[Free Full Text]

9. Savage RB, Hussey MJ, Hurie MB. A successful approach to immunizing men who have sex with men against hepatitis B. Public Health Nurs. 2000;17:202–206.[Medline]

10. Seal KH, Ochoa KC, Hahn JA, Tulsky JP, Edlin BR, Moss AR. Risk of hepatitis B infection among young injection drug users in San Francisco: opportunities for intervention. West J Med. 2000;172:16–20.[Medline]

11. Heptonstall J. Strategies to ensure delivery of hepatitis B vaccine to injecting drug users. Commun Dis Public Health. 1999;2:174–177.[Medline]

12. Rhodes SD, DiClemente RJ, Yee LJ, Hergenrather KC. Hepatitis B vaccination in a high risk MSM population: the need for vaccination education. Sex Transm Infect. 2000;76:408–409.[Free Full Text]

13. MacKellar DA, Valleroy LA, Secura GM, et al. Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health. 2001;91:965–971.[Abstract]

14. Hagan H. Vaccination could improve overall health in a high risk population. West J Med 2000; 172: 21.[Medline]




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