Abstract
Poor compliance with multi-dose vaccine schedules by adults for whom hepatitis (Hep) A and B vaccines are recommended contributes to major Hep A and B disease burdens among high-risk U.S. adults. Evidence on hepatitis vaccine series adherence, completion, timeliness of completion, and factors associated with these outcomes, is limited and not readily generalizable for U.S. adults. This retrospective, observational study examined adherence, completion, its timeliness, and the impact of sociodemographic and clinical factors on these outcomes among a large, geographically representative sample of U.S. adults. We analyzed the Optum Clinformatics SES administrative claims database (1/1/2010-6/30/2020) for recipients of 2-dose (HepA, HepB2) or 3-dose (HepB3, HepAB) hepatitis vaccines. Adherence was defined as receipt of booster doses within specified assessment periods, per label-recommended schedules. Completion (receipt of all doses) was assessed at 6, 12, 18, and 24 months.The study included 356,828 adults ≥19 years old who were continuously enrolled in a medical benefit plan for one (HepB2), six (HepB3; HepAB), or 18 months (HepA) prior to and following the index date (first observed vaccine dose). Adherence and 24-month completion rates were: HepA (27.0%, 28.4%), HepB2 (32.2%, 44.8%), HepB3 (14.3%, 37.3%), HepAB, (15.3%, 33.8%). Kaplan-Meier completion curves plateaued after about 6 months for HepB2 and about 12 months for HepA, HepB3, and HepAB vaccines. Logistic regression analyses showed risk for low adherence/completion was generally associated with male gender, younger age, Black or Hispanic race/ethnicity, lower educational or household income attainment, and more comorbidities. Adherence and completion rates for all hepatitis vaccine series are low, especially for males, younger adults, those with lower socio-economic status and more comorbidities. To our knowledge, this is the largest claims-based analysis of adherence and completion rates for U.S. adults initiating all currently available HepA and HepB vaccines. Findings may inform hepatitis vaccination programming.
Highlights
The disease burden of viral hepatitis remains substantial globally and persistent in high income countries, including the USA [1]
After applying all inclusion/exclusion criteria, the number of patients included in the study who initiated each vaccine were: HepA, 93,986; HepB2, 6,795; HepB3, 191,761; HepAB, 64,286
Completion rates were higher when adults without 24-months of eligibility were retained in the analysis, but these rates generally plateaued after about 6 months for HepB2 and about 12 months for HepA, HepB3, and HepAB vaccines, consistent with previous reports in the literature [11, 12]
Summary
The disease burden of viral hepatitis remains substantial globally and persistent in high income countries, including the USA [1]. The World Health Organization (WHO) estimates that chronic viral hepatitis caused 1.34 million deaths in 2015 from liver cancer, cirrhosis and other conditions [2]. About 325 million people worldwide live with Hepatitis (Hep) B and/or C, the virus types which cause most deaths. In the US, the most common viral types are HepA, B and C. Prevention of these diseases remains challenging, including for the vaccine-preventable liver diseases caused by HepA and B and especially among people with specific risk factors
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