Multidose Hepatitis Vaccine Adherence in US Adults May Be Suboptimal

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The majority of adults initiating vaccination may not receive the full protective benefit because they do not complete the dosage in the recommended timeframe.
The majority of adults initiating vaccination may not receive the full protective benefit because they do not complete the dosage in the recommended timeframe.

One-dose or two-dose schedules may increase vaccine effectiveness as opposed to multidose vaccines for hepatitis A, B, and A/B, as adherence to the latter dosing regimen is low, according to a study published in Vaccine.

Researchers utilized MarketScan Research Databases to identify completion of hepatitis A, B, and combination A/B recommended vaccine schedules from 2008 to 2015 in adults aged ≥19 years. The researchers assessed adherence to dose timing with the recommended 2-dose (hepatitis A) and 3-dose (hepatitis B and hepatitis A/B) schedules.

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Completion of vaccine was recorded at the minimum dose spacing per each vaccine and again at 12 and 24 months.

A total of 367,814 individuals (55% women; mean age, 39.4 years) began the hepatitis A vaccine schedule; however, only 27.1% were found to have received the second dose as per schedule (within 18 months of the first dose).  The lowest rate of adherence was identified in individuals aged ≥70 years (23.2%), and the highest rate was found in those aged 60 to 64 years (35.0%). At conclusion of follow-up (42 months), 32.1% completed the two-dose regimen.

A total of 535,759 individuals (59% women; mean age, 40.9 years) began the hepatitis B vaccine schedule. Vaccine completion varied by age: 29.5% for adults aged ≥70 years and 40.4% for those aged 60 to 64 years. Approximately one-third of adults (31.17%) who initiated the hepatitis B series completed all 3 doses within 2 years of the minimum recommended spacing.  The lowest completion was seen in adults aged ≥70 years (25.4%), and the highest completion was seen in those aged 60 to 64 years (39.9%).

A total of 178,033 individuals (57.0% women; mean age, 45.0 years) began the hepatitis A/B vaccine schedule. Within 1 month, approximately 40% completed a second dose, with 37.3% of individuals ranging from 19 to 45 years and 45.5% aged 60 to 64 years. By 13 months, 57.3% of individuals completed a second dose. Only 18.0% of individuals had completed 3 doses by 6 months, and 32.3% of individuals had successfully completed the third dose by 30 months.

“Adherence with and completion of the recommended multidose schedules for HepA, HepB, and HepA-HepB are low, and the vast majority of adults initiating vaccination may not be receiving the full protective benefit of these multidose vaccines due to receipt outside the optimal time frame or failure to complete the series,” the research team concluded. “Thus, one- or two-dose vaccines may maximize vaccine effectiveness over vaccines requiring more doses.”

Disclosure: This study was funded by Merck Sharp & Dohme Corp.

Reference

Trantham L, Kurosky SK, Zhang D, Johnson KD. Adherence with and completion of recommended hepatitis vaccination schedules among adults in the United States [published online June 13, 2018]. Vaccine. doi: 10.1016/j.vaccine.2018.05.111

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