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Vaccination against hepatitis B virus among people who inject drugs – A 20 year experience from a Swedish needle exchange program

Alanko Blomé, M. LU ; Björkman, P. LU ; Flamholc, L. LU ; Jacobsson, H. and Widell, A. LU (2017) In Vaccine 35(1). p.84-90
Abstract

Background People who inject drugs (PWID) are at particular risk of hepatitis B virus (HBV) acquisition, but often have poor access or adherence to HBV vaccination. Vaccination against HBV has been offered at a major Swedish needle exchange program (NEP) since 1994. The aim of this study was to evaluate vaccine completion and response rates, and the effect of sequential booster doses to non-responders to the standard vaccination schedule. Methods PWID enrolled in the NEP 1994–2013, without serological markers for HBV at baseline (negative for HBsAg/anti-HBc/anti-HBs), were offered a three-dose standard intramuscular vaccination schedule (Engerix®-B, GSK, 20 μg/mL, intended to be received at months 0, 1 and 6). Vaccination response was... (More)

Background People who inject drugs (PWID) are at particular risk of hepatitis B virus (HBV) acquisition, but often have poor access or adherence to HBV vaccination. Vaccination against HBV has been offered at a major Swedish needle exchange program (NEP) since 1994. The aim of this study was to evaluate vaccine completion and response rates, and the effect of sequential booster doses to non-responders to the standard vaccination schedule. Methods PWID enrolled in the NEP 1994–2013, without serological markers for HBV at baseline (negative for HBsAg/anti-HBc/anti-HBs), were offered a three-dose standard intramuscular vaccination schedule (Engerix®-B, GSK, 20 μg/mL, intended to be received at months 0, 1 and 6). Vaccination response was defined as protective levels of anti-HBs (⩾10 mIU/mL). Up to three booster doses were then offered for non-responders, each followed by anti-HBs testing. Results HBV data was available for 2352 identifiable individuals at NEP enrolment, of whom 1516 (64.5%) had no markers for previous HBV exposure or vaccination. Vaccination was initiated for 1142 (75.3%) individuals and 898 (59.2%) completed the standard vaccination schedule. Post-vaccination anti-HBs levels were available from 800 individuals, with 598 (74.8%) responding to the basic vaccination schedule. After up to three booster doses a total of 676 (84.5%) individuals achieved protective anti-HBs levels. Non-response to vaccination was associated with higher age and anti-HCV positivity (p < 0.001). Eighteen incident cases of HBV infection were observed among vaccine non-responders, as well as 30 cases among those who had not completed vaccination. Conclusion We demonstrate the feasibility of including HBV vaccination in the services offered by a NEP, with completion of vaccination in a majority of HBV-susceptible PWID. The response to HBV vaccination among PWID was relatively low; however, the addition of up to three booster doses improved the response rate from 74.8 to 84.5%.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Hepatitis B, Needle exchange program, NEP, People who inject drugs, PWID, Vaccination
in
Vaccine
volume
35
issue
1
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:84999780494
  • wos:000390517900012
ISSN
0264-410X
DOI
10.1016/j.vaccine.2016.11.041
language
English
LU publication?
yes
id
162d9a06-5356-4ee0-80a8-23664bea20c6
date added to LUP
2016-12-28 11:03:22
date last changed
2018-11-21 21:28:33
@article{162d9a06-5356-4ee0-80a8-23664bea20c6,
  abstract     = {<p>Background People who inject drugs (PWID) are at particular risk of hepatitis B virus (HBV) acquisition, but often have poor access or adherence to HBV vaccination. Vaccination against HBV has been offered at a major Swedish needle exchange program (NEP) since 1994. The aim of this study was to evaluate vaccine completion and response rates, and the effect of sequential booster doses to non-responders to the standard vaccination schedule. Methods PWID enrolled in the NEP 1994–2013, without serological markers for HBV at baseline (negative for HBsAg/anti-HBc/anti-HBs), were offered a three-dose standard intramuscular vaccination schedule (Engerix®-B, GSK, 20 μg/mL, intended to be received at months 0, 1 and 6). Vaccination response was defined as protective levels of anti-HBs (⩾10 mIU/mL). Up to three booster doses were then offered for non-responders, each followed by anti-HBs testing. Results HBV data was available for 2352 identifiable individuals at NEP enrolment, of whom 1516 (64.5%) had no markers for previous HBV exposure or vaccination. Vaccination was initiated for 1142 (75.3%) individuals and 898 (59.2%) completed the standard vaccination schedule. Post-vaccination anti-HBs levels were available from 800 individuals, with 598 (74.8%) responding to the basic vaccination schedule. After up to three booster doses a total of 676 (84.5%) individuals achieved protective anti-HBs levels. Non-response to vaccination was associated with higher age and anti-HCV positivity (p &lt; 0.001). Eighteen incident cases of HBV infection were observed among vaccine non-responders, as well as 30 cases among those who had not completed vaccination. Conclusion We demonstrate the feasibility of including HBV vaccination in the services offered by a NEP, with completion of vaccination in a majority of HBV-susceptible PWID. The response to HBV vaccination among PWID was relatively low; however, the addition of up to three booster doses improved the response rate from 74.8 to 84.5%.</p>},
  author       = {Alanko Blomé, M. and Björkman, P. and Flamholc, L. and Jacobsson, H. and Widell, A.},
  issn         = {0264-410X},
  keyword      = {Hepatitis B,Needle exchange program,NEP,People who inject drugs,PWID,Vaccination},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {84--90},
  publisher    = {Elsevier},
  series       = {Vaccine},
  title        = {Vaccination against hepatitis B virus among people who inject drugs – A 20 year experience from a Swedish needle exchange program},
  url          = {http://dx.doi.org/10.1016/j.vaccine.2016.11.041},
  volume       = {35},
  year         = {2017},
}