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Translation of biomedical prevention strategies for HIV: prospects and pitfalls. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S12-25. [PMID: 23673881 DOI: 10.1097/qai.0b013e31829202a2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother-to-child transmission. In recent years, antiretroviral drugs to reduce the risk of transmission (when the infected person takes the medicines; treatment as prevention) or reduce the risk of acquisition (when the seronegative person takes them; preexposure prophylaxis) have proven to be efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (ie, screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV-prevention strategies such as family planning for HIV-infected women who do not want more children and prevention of mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach.
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Slade EP, Rosenberg S, Dixon LB, Goldberg RW, Wolford GL, Himelhoch S, Tapscott S. Costs of a public health model to increase receipt of hepatitis-related services for persons with mental illness. Psychiatr Serv 2013; 64:127-33. [PMID: 23475451 PMCID: PMC3637942 DOI: 10.1176/appi.ps.000852011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study examined the costs and impact on receipt of hepatitis and HIV testing and hepatitis immunization services of a public health intervention model that was designed for use by persons with serious mental illness and co-occurring substance use disorders. METHODS Between 2006 and 2008, a random sample of 202 nonelderly, predominantly African-American males with a psychotic or major depressive disorder and a co-occurring substance use disorder was recruited at four community mental health outpatient programs in a large metropolitan area. Participants were randomly assigned at each site to enhanced treatment as usual (N=97), including education about blood-borne diseases and referrals for testing and vaccinations, or to an experimental intervention (N=105) that provided on-site infectious disease education, screening of risk level, pretest counseling, testing for HIV and hepatitis B and C, vaccination for hepatitis A and B, and personalized risk-reduction counseling. The authors compared the two study groups to assess the average costs of improving hepatitis and HIV testing and hepatitis A and B vaccination in this population. RESULTS The average cost per participant was $423 for the intervention and $24 for the comparison condition (t=52.7, df=201, p<.001). The costs per additional person tested was $706 for hepatitis C, $776 for hepatitis B, and $3,630 for HIV, and the cost per additional person vaccinated for hepatitis was $561. CONCLUSIONS Delivery of hepatitis and HIV public health services to persons with serious mental illness in outpatient mental health settings can be as cost-effective as similar interventions for other at-risk populations.
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Affiliation(s)
- Eric P Slade
- Veterans Affairs CapitolHealth Care Network (Veterans Integrated Service Network), Mental Illness Research, Education and Clinical Center, Baltimore, MD, USA.
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Attilio JS, Rodrigues FP, Renovato RD, Sales CDM, Alvarenga MRM, Moreira MT, Pereira NCA. Cobertura vacinal contra hepatite B entre usuários de drogas ilícitas. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar a cobertura vacinal contra a hepatite B e os comportamentos de risco entre usuários de drogas ilícidas (UDI) em Dourados-MS. MÉTODOS: Trata-se de uma pesquisa de campo, descritiva de corte transversal realizada mediante aplicação de questionário em 49 usuários atendidos pelos centros de recuperação e programas de apoio desse Município. RESULTADOS: Identificou-se predomínio de homens jovens que utilizavam drogas não injetáveis. A história de prisão, e de hepatite na família, tatuagens, múltiplos parceiros sexuais e realização de todas as formas de relação sexual, foram os fatores de risco mais frequentes. CONCLUSÃO: Estes fatores combinados com a baixa cobertura vacinal e a falta de término do esquema confirmam a vulnerabilidade do grupo em adquirir a hepatite B.
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Kazi S, Boroumand S. Assessing Quality of Primary Care Provided to the HIV-Infected Ryan White Population in the Baltimore Eligible Metropolitan Area. Am J Med Qual 2008; 23:484-91. [DOI: 10.1177/1062860608324174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shazia Kazi
- City of Baltimore Health Department, Baltimore, MD,
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Maru DSR, Bruce RD, Basu S, Altice FL. Clinical outcomes of hepatitis C treatment in a prison setting: feasibility and effectiveness for challenging treatment populations. Clin Infect Dis 2008; 47:952-61. [PMID: 18715156 PMCID: PMC4847716 DOI: 10.1086/591707] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND More than one-third of people in the United States with hepatic C virus (HCV) infection pass through the correctional system annually. Data are lacking on outcomes of treatment with pegylated interferon plus ribavirin (PEG-RBV) in correctional settings. METHODS During 2002-2006, we analyzed patients in the Connecticut Department of Correction who received PEG-RBV. We assessed the rates of sustained virological response, hospitalization, and use of medications to treat psychiatric disorders and anemia. RESULTS Of 138 treatment-naive patients referred for treatment, 68 (49%) were approved. Overall, sustained virological response occurred in 47.1% of patients (for HCV genotype 1, 43.1%; for HCV genotypes 2 and 3, 58.8%). Only 9 patients (13%) discontinued treatment because of adverse effects. Multiple regression analysis revealed that not achieving a sustained virological response was correlated with HCV genotype 1 infection plus cirrhosis (adjusted odds ratio, 12.9; 95% confidence interval, 1.1-148) and baseline major depression (adjusted odds ratio, 3.4; 95% confidence interval, 1.01-11.6), but not with HIV infection, a baseline HCV RNA level >or=400,000 IU/mL, or black race. Compared with baseline, the rate of prescription of a new mood stabilizer (2.2 vs. 0.8 prescriptions per person-year) or an opioid (1.8 vs. 0.5 prescriptions per person-year) was higher during treatment, whereas there was no change in the rate of prescription of benzodiazepines and antipsychotic medications. CONCLUSIONS These results support the feasibility and clinical effectiveness of PEG-RBV for the treatment of chronic HCV infection in correctional facilities.
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Affiliation(s)
- Duncan Smith-Rohrberg Maru
- Yale AIDS Program, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
| | | | - Sanjay Basu
- Yale AIDS Program, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - Frederick L. Altice
- Yale AIDS Program, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
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Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc 2007; 82:967-75. [PMID: 17673066 DOI: 10.4065/82.8.967] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatitis B virus (HBV) is a common viral pathogen that causes a substantial health burden worldwide. Significant progress has been made in the past few decades in understanding the natural history of HBV infection. A dynamic balance between viral replication and host immune response is pivotal to the pathogenesis of liver disease. In immunocompetent adults, most HBV infections spontaneously resolve, whereas in most neonates and infants they become chronic. Those with chronic HBV may present in 1 of 4 phases of infection: (1) in a state of immune tolerance, (2) with hepatitis B e antigen (HBeAg)positive chronic hepatitis, (3) as an inactive hepatitis B surface antigen carrier, or (4) with HBeAg-negative chronic hepatitis. Of these, HBeAg-positive and HBeAg-negative chronic hepatitis may progress to cirrhosis and its long-term sequelae including hepatic decompensation and hepatocellular carcinoma. Several prognostic factors, such as serum HBV DNA concentrations, HBeAg status, serum aminotransferases, and certain HBV genotypes, have been identified to predict long-term outcome. These data emphasize the importance of monitoring all patients with chronic HBV infection to identify candidates for and select optimal timing of antiviral treatment, to recognize those at risk of complications, and to implement surveillance for early detection of hepatocellular carcinoma.
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Affiliation(s)
- Surakit Pungpapong
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Brim N, Zaller N, Taylor LE, Feller E. Twinrix®vaccination schedules among injecting drug users. Expert Opin Biol Ther 2007; 7:379-89. [PMID: 17309329 DOI: 10.1517/14712598.7.3.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twinrix is the only licensed vaccine that provides dual protection against infection with hepatitis A virus (HAV) and hepatitis B virus (HBV). The standard vaccination schedule for Twinrix is 0, 1 and 6 months. However, many high-risk populations, such as injecting drug users (IDUs), do not complete the vaccination series and, thus, do not acquire sufficient immunity against HAV and HBV. Twinrix can be administered using an accelerated vaccination schedule of 0, 7 and 21 days, with a booster recommended at 12 months. This manuscript reviews the available literature on vaccinating IDUs against HAV and HBV. The authors conclude that there is insufficient evidence regarding whether the accelerated Twinrix HAV/HBV vaccination schedule would yield a greater number of IDUs protected against both HAV and HBV.
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Affiliation(s)
- Nancy Brim
- Brown Medical School, Providence, Rhode Island, USA, 2The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA.
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Abstract
Prevention of viral hepatitis infection involves health measures designed to avert transmission of viral agents and promote the use of gammaglobulin and vaccines. The availability of safe drinking water and improvements in quality of life result in better individual hygiene; these factors have had the greatest impact on hepatitis A prevention. Serum gammaglobulin administration has been replaced by vaccinations for pre-exposure, and to a great extent for post-exposure prophylaxis because of the progressively lower anti-HAV content of gammaglobulin and the short duration of the protective effect. Universal vaccination in childhood is the recommended measure for controlling hepatitis A. Adults belonging to high-risk groups should also undergo vaccination. The incidence of hepatitis B has decreased worldwide because of universal vaccination programs, initiated in preadolescence and childhood. Prevention of hepatitis C requires control of situations in which there is a likelihood of parenteral infection with the virus. Post-transfusion hepatitis has been virtually eradicated, but considerable effort is still needed to prevent nosocomial hepatitis.
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Affiliation(s)
- Miguel Bruguera
- Servicio de Hepatología, Hospital Clínic de Barcelona y Departamento de Medicina, Universidad de Barcelona, España.
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Abstract
The worldwide burden of hepatitis B mandates accurate and timely diagnosis of patients infected with the hepatitis B virus (HBV) and the use of treatment strategies derived from evidence-based guidelines. HBV is a DNA virus that produces a series of viral protein products circulating HBV DNA. Serologic and nucleic acid testing are critical to disease prevention and treatment objectives. Information from such testing helps determine patients' infectivity and immune status, appropriate monitoring strategies, and the efficacy of treatment, as well as providing data that contributes to a better understanding of the natural history and epidemiology of the disease. This article reviews the clinical use of state-of-the-art serologic and nucleic acid tests, including the relevance of hepatitis B e antigen and antibody and HBV DNA measurements as markers of disease activity. Viral load can be used to distinguish between active and inactive disease, define response to therapy, and detect the development of antiviral resistance. Some recent reports have suggested that high viral load is associated with poorer patient outcomes (eg, more rapid progression to cirrhosis and a higher incidence of hepatocellular carcinoma). Durable suppression of HBV DNA is evolving to become the primary goal of therapy, although all currently licensed medications have used histology as the primary end point of therapy. Suggested frequencies for HBV DNA monitoring are presented.
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Affiliation(s)
- Robert G Gish
- Division of Hepatology and Complex GI, Physician Foundation, California Pacific Medical Center, San Francisco, California, USA.
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Kim SY, Billah K, Lieu TA, Weinstein MC. Cost effectiveness of hepatitis B vaccination at HIV counseling and testing sites. Am J Prev Med 2006; 30:498-506. [PMID: 16704944 DOI: 10.1016/j.amepre.2006.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 01/13/2006] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite recent significant achievements in controlling hepatitis B virus (HBV) infection, immunizing high-risk groups against the disease remains a public health challenge in the United States. The aims of this article are to evaluate the projected cost effectiveness of hepatitis B vaccination of adults attending two major types of publicly funded HIV counseling and testing sites (CTSs)-freestanding HIV CTSs and sexually transmitted disease (STD) clinics, and to compare the cost-effectiveness of alternative vaccination and testing strategies in different subgroups in this population. METHODS A decision model was developed to determine the economic and clinical consequences, from a societal perspective, of the following strategies in two hypothetical cohorts of 100,000 adults attending each type of site: (1) routine vaccination without screening, (2) screening for antibody to hepatitis B core antigen with an initial vaccine dose during the first visit, (3) screening and vaccination based on screening results, and (4) no intervention. Life expectancy, expected quality-adjusted life years (QALYs), and medical care costs were estimated for each strategy and at each site. RESULTS Routine vaccination was both more effective and more cost-effective than either screening strategy; under base-case assumptions, routine vaccination would cost $4400 both per QALY and per life year saved. Results for STD clinics were very similar in magnitude to those for freestanding CTSs. Results were most sensitive to clients' time and travel costs for return visits and the time-discount rate. CONCLUSIONS Routine provision of hepatitis B vaccine at major HIV CTSs would be a highly effective and cost-effective approach to preventing hepatitis B among high-risk adults in the United States.
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Affiliation(s)
- Sun-Young Kim
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Buck JM, Morrow KM, Margolis A, Eldridge G, Sosman J, MacGowan R, Binson D, Kacanek D, Flanigan TP, Gaiter J, MacGowan R, Wolitski R, Margolis A, Belcher L, Lifshay J, McFarlane M, O’Leary A, Eldridge G, Askew J, Fitterling J, Fortenberry M, Griebler J, Kennedy S, McGregor S, Vardaman J, Sturges J, Seal D, Hartmann B, Simms R, Reed R, Rompa D, Sosman J, Morrow K, Niaura R, Flanigan T, Fitzgerald C, Lugo R, Strother D, Kacanek D, Grinstead O, Faigeles B, Binson D, Woods W, Zack B, Bracho R, Johnson C, Silber E. Hepatitis B Vaccination in Prison: The Perspectives of Formerly Incarcerated Men. JOURNAL OF CORRECTIONAL HEALTH CARE 2006. [DOI: 10.1177/1078345806287937] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jessica M. Buck
- Pritzker School of Medicine, University of Chicago, Illinois
| | - Kathleen M. Morrow
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown Medical School, Providence, Rhode Island
| | - Andrew Margolis
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - James Sosman
- Department of Medicine, University of Wisconsin Medical School, Madison
| | - Robin MacGowan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Timothy P. Flanigan
- Department of Medicine, The Miriam Hospital and Brown Medical School, Providence, Rhode Island
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Kottiri BJ, Friedman SR, Euler GL, Flom PL, Sandoval M, Neaigus A, Des Jarlais DC, Zenilman JM. A community-based study of hepatitis B infection and immunization among young adults in a high-drug-use neighborhood in New York City. J Urban Health 2005; 82:479-87. [PMID: 16033931 PMCID: PMC3456058 DOI: 10.1093/jurban/jti095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a community-based study of the prevalence and correlates of hepatitis B virus (HBV) infection and immunization among young adults in a "drug supermarket" neighborhood in New York City. Four hundred eighty-nine young adults ages 18-24 years were recruited from Bushwick, Brooklyn through multistage household probability sampling (n = 332) and targeted sampling (n = 157), interviewed, and tested for three hepatitis B markers (HBsAg, anti-HBc, and anti-HBs). Serological evidence of HBV infection was found in 8.0% (6.0% in the household sample and 12.1% in the targeted sample) and of hepatitis B immunization in 19.6% (22.6% in the household sample and 13.4% in the targeted sample). HBV infection was higher among young adults who either used crack or injected drugs and among those who traded sex for money or drugs. Having Medicaid was significantly associated with lower odds of infection in the household sample and higher odds of immunization in the targeted sample. Although adolescent hepatitis B immunization has been a public health priority in the United States since 1995, nearly three-quarters of young adults in this community did not have serological evidence of being either exposed or immunized. Whereas subsequent younger generations benefited from universal childhood hepatitis B immunization, this particular cohort of young adults who live in communities like Bushwick presents a unique group for prevention intervention.
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Affiliation(s)
- Benny J Kottiri
- Office of HIV AIDS, US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523, USA.
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Tung CS, Middleman AB. An evaluation of school-level factors used in a successful school-based hepatitis B immunization initiative. J Adolesc Health 2005; 37:61-8. [PMID: 15963908 DOI: 10.1016/j.jadohealth.2004.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 07/08/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the effect of different school-level factors on the percent return of consent or refusal forms, the percent student participation/enrollment rate, and the percent completion rate of all 3 immunizations in the vaccination series in a school-based hepatitis B immunization initiative. METHODS The Houston Hepatitis B Immunization Initiative (HBII) was conducted from 1998 through 2001 to provide free hepatitis B immunizations to elementary school students in low socioeconomic areas. At the end of each academic school year, the nurse from each school participating in the initiative was asked to complete a survey evaluating the different strategies utilized in each school to aid in the program's success. The effect of different organizational methods on rate of return of consent/refusal forms, participation rates, and immunization completion rates from the program year 1999-2000 was determined using frequencies, Mann-Whitney analyses, Kruskal-Wallis analyses, and Spearman's correlations. RESULTS An increase in percent return of signed consent/refusal forms was more likely when teachers helped in publicity/promotion (p = .012) and educational packet distribution (p = .041). Additionally, when teachers assumed responsibility for collecting the forms, the percent return of signed consent/refusal forms (p = .018) and the percent of students receiving all 3 vaccines in the series through HBII (p = .030) were more likely to increase. An increase in signed consent/refusal forms returned was also associated with increased rates of student participation in the program for each school. In schools where students helped specifically with educational packet distribution (p = .039), the percent of students receiving at least 1 vaccine dose from the program was more likely to be higher. CONCLUSIONS The involvement of teachers in vaccination programs is very important for program success, especially in the enrollment and return of consent/refusal form phases of immunization initiatives. Student involvement may empower the students and encourage other students to participate in the program. Future school-based immunization initiatives can utilize these data to incorporate the most effective school-level factors into their programs to maximize the number of students immunized.
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Affiliation(s)
- Celestine S Tung
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Slonim AB, Roberto AJ, Downing CR, Adams IF, Fasano NJ, Davis-Satterla L, Miller MA. Adolescents' knowledge, beliefs, and behaviors regarding hepatitis B: Insights and implications for programs targeting vaccine-preventable diseases. J Adolesc Health 2005; 36:178-86. [PMID: 15737772 DOI: 10.1016/j.jadohealth.2004.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 01/24/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE To gain a better understanding of adolescents' knowledge, beliefs, and behaviors regarding hepatitis B. METHOD Three types of data were collected as part of this investigation: (a) 45 in-depth individual interviews with staff from 20 adolescent health, sexually transmitted disease (STD), and family planning clinics; (b) 96 individual interviews with adolescents and young adults; and (c) questionnaires completed by 17,063 adolescents and young adults. All instruments focused on one or more of the following five topics: (a) knowledge about vaccines; (b) knowledge about hepatitis B; (c) barriers to vaccine acceptance, and ways to overcome these barriers; (d) benefits of the vaccine acceptance, and ways to enhance these benefits; and (e) eight hepatitis B risk factors. Interview data was analyzed using qualitative thematic note-based analyses. Survey data was analyzed using descriptive statistics and Chi-square tests. RESULTS Adolescents and young adults seen in these clinics know very little about vaccinations in general, or hepatitis B, in particular. Adolescents exhibit low levels of perceived susceptibility, severity, response efficacy, and self-efficacy toward hepatitis B and the hepatitis B vaccine. On average, these adolescents engage in 2.36 high-risk behaviors (the most frequent of which include sexual activity, body piercing, and tattooing). Those who were sexually active, had a tattoo, had a STD, or worked with blood were significantly more likely to begin the vaccination series. CONCLUSIONS There is a clear need for additional educational efforts regarding both vaccinations in general, and hepatitis B in particular. Though adolescents are engaging in a variety of high-risk behaviors, most perceive their risk to be low, and therefore many are not taking the necessary precautions to protect themselves.
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Affiliation(s)
- Amy B Slonim
- Michigan Public Health Institute, Okemos, Michigan, USA
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Abstract
Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. IDUs who use mobile health care services linked to a syringe exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core anti-bodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, home-less, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR = 1.06, 95% CI = 1.04-1.07), injecting daily (OR = 2.12, 95% CI = 1.36-6.73), and being homeless (OR = 1.98, 95% CI = 1.14-12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.
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Affiliation(s)
- Frederick L Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA.
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Kim WR, Benson JT, Therneau TM, Torgerson HA, Yawn BP, Melton LJ. Changing epidemiology of hepatitis B in a U.S. community. Hepatology 2004; 39:811-6. [PMID: 14999701 DOI: 10.1002/hep.20098] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite a reduction in newly acquired hepatitis B virus (HBV) infections since the mid-1980s, HBV remains an important cause of liver disease in the U.S. We report the prevalence of chronic HBV infection in a U.S. community and describe demographic and clinical characteristics. The Rochester Epidemiology Project records healthcare encounters of residents of Olmsted County, Minnesota. For all cases with a potential diagnosis of hepatitis B in this database, complete medical records were reviewed to identify subjects who met the inclusion criteria, i.e., a clinician diagnosis of chronic HBV infection and a laboratory record of positive hepatitis B surface antigen (HBsAg). There were 191 residents with chronic HBV infection in the community, consisting of 53% Asian, 29% African, 13% Caucasian, and 5% other or unknown race. The overall age- and sex-adjusted prevalence of HBV in this community was 0.15% in 2000. The race-specific prevalence was highest among Asians (2.1%), followed by African Americans (1.9%). The prevalence among Caucasians was 0.02%. Overall, 86% were born outside the U.S., 98% of whom were non-Caucasian. A total of 131 residents were tested for HBV replicative status, of whom 27% had viral replication. Of those tested for aminotransferases (n = 184), 28% had an abnormal value at least once. In a multivariable regression analysis, replicative status was the most influential (odds ratio [OR] = 5.98, P <.01) factor associated with abnormal aminotransferase values, followed by male gender (OR = 3.69) and age greater than 40 years (OR = 2.32 per decade). In conclusion, in this Midwestern community, chronic HBV infection was predominantly seen in immigrants from endemic parts of the world.
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Affiliation(s)
- W Ray Kim
- Division of Gastroenterology and Hepatology (Mayo 16E), Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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Sansom S, Rudy E, Strine T, Douglas W. Hepatitis A and B vaccination in a sexually transmitted disease clinic for men who have sex with men. Sex Transm Dis 2003; 30:685-8. [PMID: 12972790 DOI: 10.1097/01.olq.0000079524.04451.4c] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted disease clinics can deliver hepatitis vaccines to men who have sex with men, but have been reluctant to do so because of perceived low vaccination completion rates. GOAL The goal was to evaluate hepatitis A and B vaccination eligibility, acceptance, and completion and the effectiveness of reminder/recall in a sexually transmitted disease clinic serving men who have sex with men. DESIGN Clients self-reported their eligibility for free vaccine. Consenting clients who accepted a first dose of vaccine were systematically assigned to receive telephone reminder/recall or standard follow-up. RESULTS Of 1203 clients, 71.8% were eligible for both vaccines; 62.6% of those eligible accepted both. Reminder/recall was associated with increased receipt of the second dose of hepatitis B vaccine (86.7% versus 80.4% among intervention and control groups, respectively), but not with completion of both vaccine series (55.9% versus 58.8%). CONCLUSION The majority of clients were eligible for both hepatitis vaccines, and most eligible clients accepted a first dose of both vaccines. Reminder/recall, as delivered at this clinic, failed to increase the proportion of clients who received all vaccine doses. New delivery mechanisms should be explored.
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Affiliation(s)
- Stephanie Sansom
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Diamond C, Thiede H, Perdue T, Secura GM, Valleroy L, Mackellar D, Corey L. Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis 2003; 30:425-32. [PMID: 12916134 DOI: 10.1097/00007435-200305000-00009] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are at risk for acquiring hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). GOAL The goal was to describe the seroprevalence of and risk factors for viral hepatitis, the frequency of vaccination against HAV and HBV, and reasons for lack of vaccination among young MSM. STUDY DESIGN We performed hepatitis serologies on 833 MSM aged 15 to 29 years who attended public venues in King County, Washington. RESULTS While 14.6% were HAV-immune due to vaccination, 13.9% had prior HAV infection; 57.9% were susceptible and 13.5% had unclear status. While 24.5% were HBV-immune due to vaccination, 13.3% had prior HBV infection; 44.2% were susceptible and 18.0% had unclear status. Prior HBV infection was associated with prior HAV infection. Men unvaccinated against HAV or HBV were unaware of the vaccines or had never been offered vaccination or perceived themselves at low risk for infection. Among 10 HCV-seropositive men, 70.0% reported injection drug use. CONCLUSION MSM must be vaccinated at an early age to prevent acquisition of HAV and HBV. Given the frequency of coinfection with HAV and HBV, a combined vaccine would be useful in this population.
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Affiliation(s)
- Catherine Diamond
- University of California Irvine Medical Center, 101 City Drive South, Building 11, Route 81, Orange, CA 92868, USA.
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Rich JD, Ching CG, Lally MA, Gaitanis MM, Schwartzapfel B, Charuvastra A, Beckwith CG, Flanigan TP. A review of the case for hepatitis B vaccination of high-risk adults. Am J Med 2003; 114:316-8. [PMID: 12681460 DOI: 10.1016/s0002-9343(02)01560-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The sequelae of hepatitis B virus infection include fulminant liver failure, chronic liver disease, hepatocellular carcinoma, and death. The hepatitis B vaccine is efficacious, safe, and cost-effective, but has been consistently underutilized in high-risk adults despite long-standing recommendations. Instituting routine hepatitis B vaccination for high-risk adults in settings such as prisons and jails, sexually transmitted disease clinics, drug treatment centers, and needle exchange programs could prevent up to 800 cases of hepatitis, and 10 deaths from hepatitis, per 10,000 vaccinations, with an overall cost savings. Low rates of completion of the three-dose series and lack of funding for adult immunizations have always been challenges to offering hepatitis B vaccines to high-risk adults. However, there is benefit to an incomplete vaccination series, and high-risk populations are accessible for follow-up vaccination outside of traditional medical settings. A clear national objective and federal funding for vaccinating high-risk adults are needed.
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Affiliation(s)
- Josiah D Rich
- The Miriam Hospital/Brown University School of Medicine, 164 Summit Avenue, Providence, RI 02906, USA.
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Hu DJ, Vitek CR, Bartholow B, Mastro TD. Key issues for a potential human immunodeficiency virus vaccine. Clin Infect Dis 2003; 36:638-44. [PMID: 12594646 DOI: 10.1086/367891] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2002] [Revised: 11/18/2002] [Indexed: 11/04/2022] Open
Abstract
A safe, effective, and affordable vaccine remains the best long-term hope for bringing the global human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic under control. Recent scientific developments have suggested that the first generation of HIV vaccines available for public health care use will likely be of low to moderate efficacy, compared with currently licensed vaccines for other diseases. Nevertheless, such "partially effective" HIV vaccines could provide considerable individual and public health benefits. A consultation was held in January 2002 to advise the Centers for Disease Control and Prevention (Atlanta, Georgia) about critical issues that need to be addressed in anticipation of the eventual licensure and availability of an HIV vaccine in the United States. The present article summarizes the major issues discussed at the consultation with regard to the potential use of a partially effective vaccine in HIV prevention programs in the United States and the activities that are needed to prepare for vaccine availability.
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Affiliation(s)
- Dale J Hu
- HIV Vaccine Section, Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Yee LJ, Rhodes SD. Understanding correlates of hepatitis B virus vaccination in men who have sex with men: what have we learned? Sex Transm Infect 2002; 78:374-7. [PMID: 12407244 PMCID: PMC1744531 DOI: 10.1136/sti.78.5.374] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Hepatitis B infection (HBV) is prevalent among men who have sex with men (MSM) and may lead to significant morbidity and death. Although an effective vaccine exists vaccination rates among MSM are low. We conducted a systematic review to synthesise the various findings from empirical correlational studies to understand HBV vaccination and series completion among MSM. METHODS We systematically searched the Medline, PubMed, EMBASE, CINAHL, ERIC, and Web of Science databases to identify the breadth of published studies pertaining to HBV vaccination among MSM and to synthesise findings from these studies to better identify common themes that may direct future research and intervention approaches. RESULTS Eight papers specifically addressed correlates of HBV vaccination among MSM. Six domains were identified as predictors of vaccination: (1) demographic variables such as younger age and higher education level; (2) knowledge of the vaccine; (3) access to health care; (4) level of "outness" regarding one's same sex sexual orientation; (5) behavioural factors including sexual and drug use behaviour; and (6) psychosocial variables. Three papers addressed predictors of vaccine series completion among MSM, observing two main domains: (1) demographic variables such as younger age and higher income level; and, (2) behavioural factors including sexual and health promotion behaviours. CONCLUSIONS Continued educational efforts, creation of environments that facilitate proper risk factor evaluation, and access to low cost vaccine may facilitate vaccine uptake. Although we observed important trends in the studies we reviewed, there is a lack of empirical research regarding this important public health issue.
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Affiliation(s)
- L J Yee
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Department of Infectious and Tropical Diseases, Keppel Street, London WC1E 7HT, UK.
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van Steenbergen JE. Results of an enhanced-outreach programme of hepatitis B vaccination in the Netherlands (1998-2000) among men who have sex with men, hard drug users, sex workers and heterosexual persons with multiple partners. J Hepatol 2002; 37:507-13. [PMID: 12217605 DOI: 10.1016/s0168-8278(02)00213-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS The Dutch Ministry of Health funded a pilot vaccination project targeting groups at high risk for sex- and drug-related hepatitis B transmission. METHODS In seven Municipal Health Service (MHS) areas, three-part hepatitis B vaccination was offered free to men who have sex with men (MSM), drug users (DUs), and heterosexuals with multiple partners, including sex workers (SWs). Four intervention areas recruited participants through care-givers and opinion leaders and offered vaccination at non-MHS sites. Three control areas only used flyers to offer vaccination at MHS during regular hours. RESULTS Over 18 months, 13808 persons enrolled for the first vaccination, representing 63% of the targeted population in the intervention areas and 23% in control areas. In intervention areas, only 19% of DUs enrolled, versus 4% in control areas. In both areas, enrollment of the targeted heterosexual population (64%) was satisfactory. MSM were most compliant in having the full series. Of vaccination sources, general practitioners (GPs) attained highest compliance (71%, odds ratio 1.82). CONCLUSIONS Dutch MHS facilities can reach high-risk individuals, but DUs require additional outreach. Vaccine coverage was disappointing, but our experience will be deployed nationwide and successful strategies might be employed elsewhere in countries of low endemicity.
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Affiliation(s)
- Jim E van Steenbergen
- Cluster Infectious Diseases, Municipal Health Service Amsterdam (GG&GD), Nieuwe Achtergracht 100, PO Box 2200, NL-1000 CE, Amsterdam, The Netherlands.
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Fabrizi F, Lunghi G, Martin P, Poordad FF. Serological and molecular testing in hepatitis B and the dialysis patient. Int J Artif Organs 2002; 25:91-9. [PMID: 11905519 DOI: 10.1177/039139880202500203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F Fabrizi
- Division of Nephrology and Dialysis, Ospedale Maggiore, Policlinico IRCCS, Milano, Italy.
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Affiliation(s)
- A S Lok
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109-0362, USA.
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Weinberg MS, Gunn RA, Mast EE, Gresham L, Ginsberg M. Preventing transmission of hepatitis B virus from people with chronic infection. Am J Prev Med 2001; 20:272-6. [PMID: 11331115 DOI: 10.1016/s0749-3797(01)00298-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with chronic hepatitis B virus (HBV) infection are the major source of HBV transmission in the United States. The Public Health Service recommends prevention counseling for HBV-infected people and vaccination of their household contacts and sexual partners. OBJECTIVES To describe the implementation of these recommendations by community physicians. METHODS Telephone survey of 69 people with chronic HBV infection and their healthcare providers, October 1997 through November 1997, in San Diego, California. MAIN OUTCOME MEASURES Counseling of people with chronic HBV infection and vaccination of their household contacts and sexual partners. RESULTS Forty-three percent of providers reported providing prevention counseling to their HBV-infected patients to reduce transmission; 16% of patients reported receiving counseling. For the 32 pairs for which both the patient and provider could be reached and the patients were aware of their HBV infection, 20 (63%) providers reported counseling patients, and 10 (50%) of these providers' patients reported receiving counseling. Fifty-five percent of providers recommended vaccination of contacts; 13% of eligible adult household contacts and sexual partners and 20% of eligible child household contacts had begun hepatitis B vaccination. CONCLUSIONS Prevention counseling of people with chronic HBV infection and vaccination of their contacts occur infrequently despite guidelines and an effective vaccine. Collaborative efforts between providers and people involved in public health are needed to improve delivery of these preventive health services.
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Affiliation(s)
- M S Weinberg
- Health and Human Services Agency, San Diego, California, USA.
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Charuvastra A, Stein J, Schwartzapfel B, Spaulding A, Horowitz E, Macalino G, Rich JD. Hepatitis B vaccination practices in state and federal prisons. Public Health Rep 2001. [DOI: 10.1016/s0033-3549(04)50035-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wilson BC, Moyer L, Schmid G, Mast E, Voigt R, Mahoney F, Margolis H. Hepatitis B vaccination in sexually transmitted disease (STD) clinics: a survey of STD programs. Sex Transm Dis 2001; 28:148-52. [PMID: 11289196 DOI: 10.1097/00007435-200103000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hepatitis B virus infection causes substantial morbidity and mortality in the United States. Sexual activity is the most commonly reported risk factor among persons with acute hepatitis B, yet hepatitis B vaccine coverage among adolescents and adults with high-risk sexual practices is low. Sexually transmitted disease (STD) clinics are potentially efficient settings for vaccine administration to persons with high-risk sexual practices; however, little is known about hepatitis B vaccination activities in these settings. GOAL To gain information about policies and activities for vaccinating against hepatitis B in STD clinic settings. STUDY DESIGN In April 1997, a questionnaire was sent to managers of 65 federally funded STD programs in state and local health departments. A similar survey was sent to 89 STD clinic managers in November 1997. RESULTS The response rate among program managers was 97% (63/65). Forty-eight percent considered hepatitis B prevention a program responsibility; 21% had developed and distributed written policies to prevent hepatitis B through vaccination; and 27% had developed policies to encourage hepatitis B education activities. The response rate among clinic managers was 82% (73/89). Forty-five percent reported that their STD clinics had implemented policies recommending hepatitis B vaccination and health education activities. Program managers and clinic managers reported that lack of funding to cover the cost of the vaccine, and lack of resources to provide prevaccination counseling, administer vaccine, and track clients for vaccine series completion were the primary barriers to the implementation of hepatitis B vaccination programs. CONCLUSIONS To enhance hepatitis B vaccination in STD clinics, existing funding sources must be accessed more effectively. Supplemental funding mechanisms for the cost of vaccine and resources for implementing vaccination programs also need to be identified. Additionally, STD clinics and programs should continue to propose and implement hepatitis B vaccination policies.
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Affiliation(s)
- B C Wilson
- Hepatitis Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Shouval D. Is universal vaccination against hepatitis B sufficient for control of HBV infection? Lessons from the immunization campaign in Italy. J Hepatol 2000; 33:1009-11. [PMID: 11131438 DOI: 10.1016/s0168-8278(00)80138-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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