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

详细信息    查看全文

• 作者：M. Alanko Blomé ; ^a ; P. Bjö ; rkman^a ; L. Flamholc^a ; H. Jacobsson^b ; A. Widell^c ; ^d ; ^{anders.widell@med.lu.se}
• 关键词：Hepatitis B ; People who inject drugs ; PWID ; Needle exchange program ; NEP ; Vaccination
• 刊名：Vaccine
• 出版年：2017
• 出版时间：3 January 2017
• 年：2017
• 卷：35
• 期：1
• 页码：84-90
• 全文大小：503 K
• 卷排序：35

文摘

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.MethodsPWID 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.ResultsHBV 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.ConclusionWe 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%.