Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

Abstract

Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% ( n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p -value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359 , Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.

Vaccination Coverage among Prisoners: A Systematic Review

“…The methods used to investigate the vaccination status of the inmates were: serological testing ( n = 10) [ 20 , 21 , 23 , 24 , 25 , 35 , 42 , 44 , 45 , 46 ], the use of questionnaires ( n = 5) [ 28 , 33 , 37 , 38 , 40 ], the combination of both ( n = 3) [ 26 , 31 , 36 ], the screening of institutional databases ( n = 5) [ 27 , 29 , 30 , 32 , 34 ], or directly by conducting a survey ( n = 5) [ 19 , 22 , 39 , 41 , 43 ].…”

“…The aim of the studies was to evaluate systematic vaccination or relevant update of the adult vaccination program ( n = 21) [ 19 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], to explore the coverage of risk groups ( n = 7) [ 20 , 23 , 36 , 42 , 43 , 44 , 45 ], including in some studies vaccination status at the time of admission to prison ( n = 6) [ 20 , 24 , 35 , 37 , 43 , 46 ]. The risk groups studied were IDUs and hepatitis C positive (HCV) in the HBV studies [ 23 , 42 , 43 , 44 , 45 ], and men who have sex with men in a combined HAV/HBV immunization study [ 19 ] and in another HAV immunization study [ 20 ].…”

“…The risk groups studied were IDUs and hepatitis C positive (HCV) in the HBV studies [ 23 , 42 , 43 , 44 , 45 ], and men who have sex with men in a combined HAV/HBV immunization study [ 19 ] and in another HAV immunization study [ 20 ]. In 11 studies (39.2%), exclusively men were included [ 19 , 21 , 25 , 29 , 34 , 35 , 36 , 37 , 39 , 41 , 42 ], in 4 studies (14.2%) only women were included [ 22 , 24 , 28 , 38 ], in 11 articles (39.2%) both sexes [ 23 , 26 , 27 , 30 , 31 , 32 , 33 , 43 , 44 , 45 , 46 ] and in 2 (7.1%) these data were not recorded [ 20 , 40 ]. The most studied vaccination coverage was HBV ( n = 21) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 42 , …”

“…Among the 21 studies that focused on HBV vaccine, five studies detailed the reasons why prisoners were not vaccinated [ 21 , 22 , 23 , 24 , 25 ]. As shown in Table 1 , most of the studies sought to update HBV vaccination programs to achieve improvements in vaccination coverage [ 21 , 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. The vaccination schedules used were different, most commonly at 0 (entry point), 1 month, 2 months, and a booster between 6–12 months.…”

“…The main reasons associated with non-vaccination when carrying out an intervention program in prisons were the release before the administration of the vaccine, previous or current infection, having previously received the vaccine, and refusal to vaccination [ 21 , 22 , 23 , 24 , 25 , 33 ]. In the Italian study published by Stasi et al, being a foreigner was a risk factor associated with not being vaccinated [ 35 ], and in the publication by Taylor et al, the most common reason for not being vaccinated was that inmates never had been offered the vaccine or that they never came to complete the guidelines once they started [ 33 ].…”