Speciality
Spotlight

   




 

Dermatology & Venereology

 

     




Hepatitis
B Vaccination




    

  • Margolis
    Harold S, Handsfield H Hunter,
    Jacobs R Jake et al for the
    Hepatitis B-WARE Study Group.

    Evaluation of office-based intervention to improve prevention counseling
    for patients at risk for
    sexually acquired hepatitis B
    virus infection.

    Am
    J Obst. Gynec. 182, Jan
    2000,1-6

     


    Hepatitis B virus
    infection remains a major
    public health problem in the
    United States, with an
    estimated 250,000 new
    infections annually during the
    past decade. 
    Most infections occur
    among young adults, and most
    of these result from exposures
    during high-risk activities.

     

    Sexual transmission accounts
    for >50% of hepatitis B
    virus infections, and although
    the proportion of infections
    attributable to men who have
    sex with men has declined the
    proportion of infections among
    persons with multiple
    heterosexual partners has
    increased.

     

    Although hepatitis B vaccine
    has been available for almost
    2 decades, vaccination of
    adults at high risk has been
    problematic. 
    Until routine infant
    and adolescent vaccination has
    produced cohorts of adults
    protected against hepatitis B
    virus infection, however,
    large number of adults will
    continue to face the health
    and economic consequence of
    hepatitis B virus-related
    liver disease.

     

    Except for those at
    occupational risk of hepatitis
    B virus infection, adults at
    risk have not been vaccinated
    for a number of reasons. These
    include lack of awareness by
    health care professionals and
    the public of risk factors for
    infection; lack of counseling
    concerning the disease, its
    consequences, and means of
    prevention; and lack of
    programs to vaccinate adults
    at risk for infection. 
    Surveillance data
    indicate that between 30% and
    40% of patients with acute
    hepatitis B had a previously
    diagnosed sexually transmitted
    disease as quoted in Unpublished
    observation by S Goldstein, et
    al for the Centers for Disease
    Control and Prevention
    .

     

    These healthcare
    encounters for treatment of
    sexually transmitted diseases
    should be considered missed
    opportunities for hepatitis B
    vaccination. However, there
    have been few attempts to
    evaluate the feasibility of
    identifying persons at risk
    for sexually transmitted
    hepatitis B virus infection
    and providing counseling and
    vaccination.

     

    The
    aim of this study was to
    determine the effectiveness of
    tools to identify and counsel
    patients at risk for sexually
    transmitted hepatitis B virus
    infection. 
    Physicians were
    randomly assigned to either an
    intervention group or a
    control group. 
    The intervention group
    was provided with materials
    intended to encourage patients
    to return for counseling and
    to guide counseling concerning
    prevention of hepatitis B
    virus infection. 
    Baseline data on 457
    patients at risk for hepatitis
    B virus infection showed that
    7% had received prevention
    counseling and 2% had begun
    hepatitis B vaccination. 
    Counseling was least
    likely to occur in
    obstetric-gynecologic
    practices, among uninsured
    patients, and among patients
    whose only risk factor was a
    diagnosis of a sexually
    transmitted disease. 
    After a 6-month
    intervention period 25% of the
    intervention group patients
    and 7% of the control group
    patients had been counseled (P
    <. 01). 
    Vaccination was more
    likely among intervention
    group patients (8% vs <1%;
    P<.001). 
    The use of tools to
    identify and counsel patients
    at risk for sexually
    transmitted hepatitis B virus
    infection resulted in
    increased office-based
    prevention activities.

         


 



 

    

Speciality Spotlight

   

     

Hepatitis B Vaccination


    

  • Margolis Harold S, Handsfield H Hunter, Jacobs R Jake et al for the Hepatitis B-WARE Study Group.
    Evaluation of office-based intervention to improve prevention counseling for patients at risk for sexually acquired hepatitis B virus infection.
    Am J Obst. Gynec. 182, Jan 2000,1-6
     
    Hepatitis B virus infection remains a major public health problem in the United States, with an estimated 250,000 new infections annually during the past decade.  Most infections occur among young adults, and most of these result from exposures during high-risk activities.
     
    Sexual transmission accounts for >50% of hepatitis B virus infections, and although the proportion of infections attributable to men who have sex with men has declined the proportion of infections among persons with multiple heterosexual partners has increased.
     
    Although hepatitis B vaccine has been available for almost 2 decades, vaccination of adults at high risk has been problematic.  Until routine infant and adolescent vaccination has produced cohorts of adults protected against hepatitis B virus infection, however, large number of adults will continue to face the health and economic consequence of hepatitis B virus-related liver disease.
     
    Except for those at occupational risk of hepatitis B virus infection, adults at risk have not been vaccinated for a number of reasons. These include lack of awareness by health care professionals and the public of risk factors for infection; lack of counseling concerning the disease, its consequences, and means of prevention; and lack of programs to vaccinate adults at risk for infection.  Surveillance data indicate that between 30% and 40% of patients with acute hepatitis B had a previously diagnosed sexually transmitted disease as quoted in Unpublished observation by S Goldstein, et al for the Centers for Disease Control and Prevention.
     
    These healthcare encounters for treatment of sexually transmitted diseases should be considered missed opportunities for hepatitis B vaccination. However, there have been few attempts to evaluate the feasibility of identifying persons at risk for sexually transmitted hepatitis B virus infection and providing counseling and vaccination.
     
    The aim of this study was to determine the effectiveness of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection.  Physicians were randomly assigned to either an intervention group or a control group.  The intervention group was provided with materials intended to encourage patients to return for counseling and to guide counseling concerning prevention of hepatitis B virus infection.  Baseline data on 457 patients at risk for hepatitis B virus infection showed that 7% had received prevention counseling and 2% had begun hepatitis B vaccination.  Counseling was least likely to occur in obstetric-gynecologic practices, among uninsured patients, and among patients whose only risk factor was a diagnosis of a sexually transmitted disease.  After a 6-month intervention period 25% of the intervention group patients and 7% of the control group patients had been counseled (P <. 01).  Vaccination was more likely among intervention group patients (8% vs <1%; P<.001).  The use of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection resulted in increased office-based prevention activities.
         

 

 

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