Factors to Consider in Targeting HBV Vaccination for High-Risk Adults

Chronic hepatitis B (HBV) is still a problem in many parts of the world and the United States, despite the availability of a vaccine. Many nations are exploring targeted HBV-vaccination programs for people who are at high risk for HBV.

Researchers from the National Institute for Public Health and the Environment in the Netherlands have published a study examining that country's targeted HBV prevention program. Published in the journal Vaccine, the study indicates that HBV vaccination programs are cost effective in certain populations of high-risk adults.

The program targets men who have sex with men (MSM), commercial sex workers (CSW), heterosexuals who change partners frequently, and injection drug users for HBV vaccination.

In the initial period that the researchers examined, 2002-2006, the researchers found that the program was most cost effective for CSW and injection drug users.

The study also examined the years from 2007 to 2012, when the Netherlands expanded the program. During this period, the researchers found lower rates of cost savings.

However, they noted that their cost savings were somewhat misleading due to the fact that more than half of CSWs are not Dutch citizens. Therefore, they are at higher risk for HBV because their countries of origin tend to have high levels of endemic HBV. Vaccination in the Netherlands creates benefits for countries from which CSWs originate and eventually return. Thus, their cost saving estimates were artificially low.

During the second period, the researchers found that the prevalence of HBV was lower in all groups than expected. They attributed this to global efforts to reduce HBV transmission and increase vaccination.

The Netherlands only began a childhood vaccination HBV program in 2011. It expects to see the benefits of this program within the next 2 decades. The researchers emphasized that even as these vaccinated children grow, the Netherlands will need to continue targeting CSWs who come from countries where HBV continues to be a problem.

The researchers concluded that many countries would save health care dollars if they vaccinated earlier. Targeted outreach programs tend to reach adults who are older than optimal; in this case the average age of the participant was 33. The ideal age for vaccination with HPV vaccine is age 15 or younger. Vaccinating people at a younger age saves more money over the long run as it prevents complications.

Reference

Mangen MJ, Stibbe H, Urbanus A, et al. National Working Group of hepatitis B behavioral risk-groups vaccination program. Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile. Vaccine. 2017 May 5. pii: S0264-410X(17)30560-1. doi: 10.1016/j.vaccine.2017.04.068. [Epub ahead of print]