Effect of a Community-Based Hepatitis B Virus Infection Detection Combined with Vaccination Program in China

Evidence on the effectiveness of hepatitis B virus (HBV) infection screening and vaccination programs remains rare in China. We used a quasi-experimental method, propensity score matching, to evaluate the effects of a community-based HBV infection detection combined with vaccination (HBVIDV) program in a pilot. Data were retrieved from the HBVIDV program implemented between July 2019 and June 2020. Outcomes were the difference between the treatment and control groups in hepatitis B vaccination (≥1 dose), hepatitis B vaccine series completion (≥3 doses), and serologic evidence of vaccine-mediated immunity. Altogether, 26,180 individuals were included, where 6160 (23.5%) individuals were assigned to the treatment group, and 20,020 (76.5%) individuals were assigned to the control group. After propensity score matching, 5793 individuals were matched. The rates of hepatitis B vaccination, hepatitis B vaccine series completion, and prevalence of vaccine-mediated immunity in the treatment and control groups were 29.0% vs. 17.8%, 22.1% vs. 13.1%, and 38.2% vs. 27.6%, respectively. The HBVIDV program was significantly associated with increased hepatitis B vaccination rate (OR, 1.884, 95% CI 1.725–2.057), hepatitis B vaccine series completion rate (OR, 1.872, 95% CI 1.696–2.065), and prevalence of vaccine-mediated immunity (OR, 1.623, 95% CI 1.501–1.755). The greater magnitude of association between HBVIDV program and outcomes was observed among adults aged 35–54 years and adults who live in rural areas. The HBVIDV program was effective in increasing the hepatitis B vaccination rate, hepatitis B vaccine series completion rate, and prevalence of vaccine-mediated immunity among adults in the pilot. Further focusing the program on special populations and regions may produce more effective results.

Immune response to hepatitis B vaccine following complete immunization of children attending two regional hospitals in the Southwest region of Cameroon: a cross sectional study

Background Hepatitis B virus (HBV) infection despite being a vaccine preventable disease remains a global public health problem. In Cameroon, the hepatitis B vaccine was introduced in the expanded program on immunisation in 2005, but there has been limited evaluation of the HBV surface antibody response post vaccination. Objective We investigated the immune response to hepatitis B vaccine in infants who received the DPT-Hep B-Hib vaccine, and we assessed HBsAg carriage in non-responders. We also investigated factors associated with non-response or poor response. Methods Using a hospital based cross sectional design and a structured questionnaire over a four-month period (January to April 2019), we collected data to determine factors associated with hepatitis B surface antibody (anti-HBs) response from infants aged 6 to 9 months attending infant welfare clinics (IWC) at the Buea and Limbe regional hospitals. We collected venous blood and measured anti-HBs titres using a quantitative Foresight® ELISA. We entered and analysed data using EpiData version 3.1 and SPSS version 25 respectively. Results Of the 161 infants enrolled, 159 (98.8%) developed anti-HBs antibodies. Of these 159, 157 (97.5%) and 117 (72.7%) developed ≥ 10.0 mIU/ml (seroprotection) and ≥ 100.0 mIU/ml anti-HBs titres respectively. Being younger (6 months old) was associated with seroprotection (Cramer V = 0.322, p = 0.001). Spearman rho’s relational analysis showed that immunity against HBV reduced as the duration since the last dose increased (r = −0.172; P = 0.029). However, a Firth logistic regression showed no significant association of factors with inadequate immunity. All 12 (7.5%) infants exposed to HBV at birth, received the hepatitis B vaccine at birth, including four who received HBIG, and all were protected. Four infants (2.5%) had anti-HBs titres < 10.0 mIU/mL (non-responders) but had no peculiarity. Conclusion The seroprotective rate following hepatitis B vaccination of infants is high even in exposed infants. Our study suggests that Cameroon’s HBV vaccine in the Expanded Program on Immunisation (EPI) is effective against HBV, although we could not account for the 2.5% non-response rate. Large scale studies are needed to further explore non-response to the vaccine.

Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy

BACKGROUND In September 2017, the American Academy of Pediatrics issued guidance recommending hepatitis B vaccine be administered to well newborns with birth weight ≥2000 g within 24 hours after birth. At that time, ∼85% of well newborns were vaccinated before discharge at our center; however, only 35% were vaccinated within 24 hours after birth. Our aim was to vaccinate 70% of eligible newborns within 24 hours after birth by June 2018 while maintaining the overall rate of vaccination. METHODS A multidisciplinary improvement team analyzed existing vaccine administration processes in the well-newborn nursery. From October 2017 to January 2018, changes were made to activation of vaccine orders and to obtaining and documenting the consent processes. Vaccine administration was bundled with routine care given ≤24 hours after birth, and parent scripting was changed from offering vaccine as an option to stating it as a recommendation. From November 2016 to June 2019, we determined the overall rate and timing of vaccination using statistical process control methods. RESULTS Among 10 887 eligible infants, the proportion administered hepatitis B vaccine ≤24 hours after birth increased from 35.5% to 78.8% after process changes with special-cause variation on process control charts. Proportion of infants receiving vaccine any time before discharge also increased from 86.5% to 92.3%. CONCLUSIONS Specific process changes allowed our birth center to comply with the recommended timing for hepatitis B vaccination of ≤24 hours after birth among eligible newborns.

The Cost of Trust: The World Health Organizations and Vaccination's Contested Economization in France

This article explores the role of the World Health Organization (WHO) within the tumultuous history of the hepatitis B vaccine in France, including a controversy that erupted in 1996 and lasted several years. When the first hepatitis B vaccine was commercialized in France in 1981, it inaugurated a new era in the industry characterized by high prices, an unprecedented number of patents and aggressive commercial competition. By inscribing the hepatitis B vaccine controversy into a broader, global history of the economization of immunization – in which the WHO played a central role – this article reframes the causes and implications of a controversy that both actors and scholars have approached through a primarily national lens. The challenge posed to the economic approach to immunization prepared the ground for subsequent critiques of vaccines as commodities. The article discusses a key transformation in the recent transatlantic history of public health by focusing on the perceived association of immunization with a contested economic order.

Survey on HBV Immunisation Status among the Dental Practitioners

Introduction: There are more than 2 billion people worldwide who have evident recent or past HBV infection and chronic cases. Hepatitis B, C and D are transmitted by parental contact with infected body fluids including blood, semen, saliva , sweat and tears , invasive medical procedures using equipment which are contaminated with the virus , vertical transmission. Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with immunisation such as from AIDS/HIV and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people routine immunisation results in more than 96% of the people being protected. Aim: The aim of this study is to know the immunisation status and knowledge and awareness among dental practitioners. Materials and Methods: A survey was designed to analyse the result. The questionnaire was prepared in Google Forms (online survey link) and was distributed to 100 dental practitioners. The responses were then collected and statistically analysed using SPSS software. Results and Discussion: After discussing the results of the present study, it was seen that many were aware of hepatitis B vaccine. Limitations of this are that the population is small. Limitations seen in this study can be included in future research for better spread of awareness among the general public. Conclusion: From the study we can conclude that the majority of the dental practitioners are aware of hepatitis B vaccine and are aware of their vaccination status of hepatitis B.

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal for rate of administration.In response to updated Advisory Committee on Immunisation Practices recommendations to administer the dose within 24 hours of birth, we used quality improvement methodology to implement changes that would increase the vaccination rates of healthy newborns in our nurseries. The goal was to improve the proportion of infants who receive the hepatitis B vaccine within 24 hours of birth to >90% within a 2-year period, with a secondary goal of increasing vaccination rates prior to discharge from the nursery to >95%.Multiple Plan–Do–Study–Act (PDSA) cycles were performed. Initial cycles focused on increasing nurse and provider awareness of the updated timing recommendations. Later cycles targeted nursing workflow to facilitate timely administration of the vaccine. We implemented changes at our university medical centre and community hospital newborn nurseries.At the university medical centre nursery, both primary and secondary goals were met; the rate of hepatitis B vaccine administration within 24 hours increased from 81.7% to 96.2%, with vaccine administration prior to discharge increasing from 93.4% to 97.9%. In the community hospital nursery, the baseline rate of hepatitis B vaccine administration within 24 hours was 78.1%, and this increased to 85.8% with the interventions, falling short of the target of >90%. Vaccine administration prior to discharge increased from 87.2% to 92.0%, also not meeting the secondary target of 95%.Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery.

Heplisav-B in Prior Hepatitis B Vaccine Nonresponders: A Case Series

ABSTRACT Introduction Hepatitis B is a potentially deadly infection that can be acquired by exposure to infectious human blood or body fluids. While service members and others at occupational risk are routinely vaccinated to prevent hepatitis B, non-responders to this vaccine are at continued risk. Heplisav-B is a newer vaccine that may offer additional protection to those at risk. Materials and Methods Cases of hepatitis B vaccine non-responders who were given Heplisav-B after receiving six or more doses of standard hepatitis B vaccine were collected from existing health records within the military health system after Uniformed Services University of the Health Sciences Institutional Review Board review. Results Twelve of thirteen (92%) prior non-responders who were tested at least 1 month after completing the recombinant Heplisav-B vaccine series demonstrated seroprotection against hepatitis B. Conclusions Ideally, all service members and other at-risk workers should be protected from hepatitis B. This case series suggests that prior non-responders are likely to gain protection from hepatitis B with Heplisav-B vaccination. A prospective trial is warranted for further evaluation of this potential indication.