Abstract
BackgroundHepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. Objective: To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection.MethodsPatients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients’ immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total.ResultsResponse rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % – 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated.ConclusionsLow HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.
Highlights
Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection
Poland is classified as a geographic region of low endemicity of the prevalence of hepatitis B surface antigen (HBsAg), HB is still a significant health burden
The authors’ choice regarding the relatively numerous group of patients involved in the pilot study was due to the fact that it was the first serosurvey conducted in Poland which queried GP clinic patients on their vaccination status with the help of questionnaires, and by obtaining their blood samples
Summary
Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. HBV vaccination is widely recommended for those not covered by the national immunisation program. According to the most recent World Health Organization estimate, two billion people worldwide have been infected with hepatitis B virus (HBV), 240 million are chronically infected, and approximately 780,000 persons die each year from hepatitis B (HB) infection – 650,000 from cirrhosis and liver cancer due to chronic HB infection and another. Poland is classified as a geographic region of low endemicity of the prevalence of hepatitis B surface antigen (HBsAg), HB is still a significant health burden. In Poland, neonatal vaccination began in 1989 with neonates born to HBsAg positive mothers.
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