How Can Hepatitis Vaccination Adherence Be Improved for At-Risk Adults?

Confident Asian woman pharmacist prepares to give Malaria, Tetanus, Typhoid, Hepatitis vaccine young to man.
Adults at risk of hepatitis A and hepatitis B have multi-dose vaccinations available, but complete and timely vaccination adherence rates are low. What can be done to encourage more vaccine adherence?

World Hepatitis Day is June 28, 2022, a day designed to raise awareness for those living with and at risk for viral hepatitis. This year’s campaign theme is “I Can’t Wait,” intended to underscore the need for timely screenings, testings, and preventive interventions.¹

Though some hepatitis vaccines are for children, there are also multi-dose vaccines for hepatitis A and hepatitis B that at-risk adults may be recommended to take. Not adhering to hepatitis vaccine schedules could worsen a patient’s disease burden. Understanding who is at risk for not following proper vaccine schedules and why may help health care professionals better develop interventions for them. Increasing adherence can reduce disease burden and put fewer people at risk. What can health care professionals do to encourage vaccine adherence?

Hepatitis Vaccination Adherence Rates

A 2022 study in PLoS One examined the completion rates for hepatitis vaccinations in American adults, and potential factors for those that did not complete their vaccinations.² The researchers examined a population of adults 19 and older who had been prescribed multi-dose HepA, HepB2, HepB3, or HepAB vaccinations. For all of these vaccines, adherence was below 50% after 6, 12, 18, and 24 months. Just 26.6% of those prescribed the 2-dose HepA vaccine had completed both doses within 18 months, and merely 28.4% within 24 months. Overall adherence to the HepA vaccine was just 27% of applicable patients. For 3-dose vaccines, overall adherence was 14.3% for the HepB3 vaccine and 15.3% for the HepAB vaccine.

Across all four vaccines, men had lower adherence rates than women. Among the HepA group, those aged 18 to 39 had significantly lower rates of completion than those aged 40 to 64 (22% to 32.2%). This age group also had lower adherence rates in the HepB3 and HepAB groups. For the HepA and HepAB group, participants aged 75 or older also had below average adherence rates.

Participants who made under $40,000 annually had lower adherence rates across all vaccines; however, participants who made over $100,000 annually had lower adherence rates than participants in the $60,000-100,000 range. Adherence rates varied among all of the vaccines for other factors such as race/ethnicity and comorbidities.

Studies have shown similar numbers in the UK, as a 2019 study in BMC Public Health found that just 11% of participating adults had completed a 2-dose Hepatitis A vaccine within 12 months.³ Only 22% completed the 3-dose hepatitis B vaccine and 10% received the 3-dose hepatitis A/B vaccine within 6 months.

Possible Interventions

The researchers in the PLoS One study attributed some groups’ disparities to concerns about cost and insurance, as well as lower confidence in the health care system. While they conclude that more research is needed to understand these factors and how to intervene, they stress the importance of following up with patients to ensure proper adherence to vaccination schedules.

A 2019 study in Open Forum Infectious Diseases analyzed different interventions used to increase hepatitis B vaccine adherence in people with injection drug use, and determined that financial incentives had the highest rate of success in increasing vaccinations.⁴ They also found that an accelerated vaccine schedule was more effective at increasing adherence.


1. World Hepatitis Day – 28 July. World Hepatitis Alliance (WHA). Accessed July 21, 2022.

2. LaMori J, Feng X, Pericone CD, Mesa-Frias M, Sogbetun O, Kulczycki A. Hepatitis vaccination adherence and completion rates and factors associated with low compliance: A claims-based analysis of U.S. adults. PLoS One. 2022 Feb 17;17(2):e0264062. doi: 10.1371/journal.pone.0264062. PMID: 35176102; PMCID: PMC8853527.

3. Johnson, K.D., Lu, X. & Zhang, D. Adherence to hepatitis A and hepatitis B multi-dose vaccination schedules among adults in the United Kingdom: a retrospective cohort study. BMC Public Health 19, 404 (2019).

4. Tressler S, Bhandari R. Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis. Open Forum Infect Dis. 2019 Dec 6;6(12):ofz521. doi: 10.1093/ofid/ofz521. PMID: 31890724; PMCID: PMC6929254.