Opportunities to Improve Hepatitis A and Hepatitis B Vaccination Coverage

Two studies on hepatitis A and hepatitis B vaccination highlight opportunities to improve coverage of ≥2 doses of hepatitis A vaccine in children and hepatitis B vaccine series completion in adults. Specifically results of these studies showed that simultaneous administration of pediatric vaccinations by age 24 months can increase the likelihood of ≥2 doses of hepatitis A vaccine, and a 2-dose adjuvanted vaccine may improve overall hepatitis B coverage. The results of these studies were presented at IDWeek 2019, held from October 2 to October 6, 2019, in Washington, DC.

Researchers analyzed data from the United States National Immunization Survey-Child for 2008 to 2017 for vaccination coverage for ≥2 doses of the hepatitis A vaccine by age 24 months.¹ The investigators evaluated the data for scenarios wherein there were missed opportunities for pediatric patients to receive ≥2 doses of the hepatitis A vaccine via simultaneous administration of other age-appropriate vaccines. A comparison of potentially achievable coverage vs reported ≥2 hepatitis A vaccinations stratified by birth year was analyzed using the Kaplan-Meier method; estimates for patients born in 2015 were stratified by state and sociodemographic factors.

Potentially achievable ≥2 hepatitis A coverage exceeded reported coverage by 10% across birth years 2007 to 2015; in 2015, and the potentially achievable ≥2 hepatitis A coverage would have surpassed the 85% Healthy People 2020 target in 10 states. The difference between potentially achievable coverage and reported vaccinations was greater when stratified by sociodemographic factors, ranging from a difference of 24.5% for children whose families live below the poverty time, 31.7% for black children, and 29% for children who were uninsured.

The investigators suggested that evidence-based interventions could help eliminate missed opportunities for simultaneous vaccination, substantially increasing ≥2 hepatitis A coverage in young children.

In a study conducted at Kaiser Permanente Southern California, researchers compared compliance in adults initiating the 3-dose hepatitis B vaccine series (administered at 0, 1, and 6 months) with those who recieved a new 2-dose adjuvanted vaccine, Heplisav-B® (administered at 0 and 1 month).² The study included adults who were not receiving dialysis who received their first dose of hepatitis B vaccine between August 7, 2019 and February 1 2019: 6500 patients were administered the Heplisav-B vaccine and 7733 received the comparator vaccine. Second dose compliance rates were estimated for the full cohort and a subset of participants were assessed for series completion within a 6-month follow-up period. Hazard ratios were measured using Cox proportional modeling and adjusted for sociodemographic factors and triggers for hepatitis B vaccination.

Compliance rates for the second dose did not significantly differ between treatment groups (adjusted hazard ratio [aHR] 1.14; 95% CI, 0.91-1.47): 32.9% of Heplisav-B group and 29.1% of the comparator group completed the second dose within 60 days. However, recipients of Heplisav-B were 5 times more likely to achieve series completion (aHR 5.17; 95% CI, 3.84-6.98) in which 56.9% of the Heplisav-B group and 20.6% of the comparator group completed their vaccination series at 210 days. In adjusted analyses, black adults were significantly less likely to comply with the second dose or complete the series; Asian adults, adults aged ≥60 years, and adults living in census blocks with median incomes of $40,000 to $69,000 were significantly more likely to comply with the second dose and achieve series completion.

The investigators concluded that a 2-dose hepatitis B vaccine could improve overall coverage and prophylaxis for infection with hepatitis B virus.

Disclosure: Multiple authors reported affiliations with the pharmaceutical industry. Please see the references for complete disclosure information.

References

1. Zhao Z, Hill H, Elam-Evans L, Chen M, Singleton JA. Potentially achievable hepatitis A vaccination coverage with simultaneous administration of vaccines among young children in the United States. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 283.

2. Bruxvoort K, Slezak J, Huang R, et al. Hepatitis B vaccine compliance: comparing 2-dose and 3-dose vaccines. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 286.