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Price O, Swanton R, Grebely J, Hajarizadeh B, Webb P, Peacock A, Dore GJ, Cowie BC, Vickerman P, Degenhardt L. Vaccination coverage among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104382. [PMID: 38503233 DOI: 10.1016/j.drugpo.2024.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND People who inject drugs may be at excess risk of acquiring vaccine-preventable diseases and negative associated health outcomes, but experience barriers to vaccination. We aimed to determine vaccination coverage among people who inject drugs globally. METHODOLOGY We conducted systematic searches of the peer-reviewed and grey literature, date limited from January 2008 to August 2023, focusing on diseases for which people who inject drugs are at elevated risk for and for which an adult vaccination dose is recommended (COVID-19, hepatitis A, hepatitis B, human papillomavirus, influenza, pneumococcal disease, tetanus). To summarise available data, we conducted a narrative synthesis. RESULTS We included 78 studies/reports comprising 117 estimates of vaccination coverage across 36 countries. Most estimates were obtained from high income countries (80%, n=94). We located estimates for hepatitis B vaccination in 33 countries, which included 18 countries with data on serological evidence of vaccine-derived hepatitis B immunity (range: 6-53%) and 22 countries with self-report data for vaccine uptake (<1-96%). Data for other vaccines were scarcer: reported hepatitis A vaccination coverage ranged 3-89% (five countries), COVID-19 ranged 4-84% (five countries), while we located estimates from fewer than five countries for influenza, tetanus, pneumococcal disease, and human papillomavirus. CONCLUSION Estimates were sparse but where available indicative of suboptimal vaccination coverage among people who inject drugs. Improving the consistency, timeliness, and geographic coverage of vaccine uptake data among this population is essential to inform efforts to increase uptake.
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Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
| | - Rosie Swanton
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | | | | | - Paige Webb
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | - Benjamin C Cowie
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
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Zovich B, Freeland C, Moore H, Sapp K, Qureshi A, Holbert R, Zambrano J, Bhangoo D, Cohen C, Hass RW, Jessop A. Dismantling Barriers to Hepatitis B and Delta Screening, Prevention, and Linkage to Care among the PWUD Community in Philadelphia. Viruses 2024; 16:628. [PMID: 38675969 PMCID: PMC11054430 DOI: 10.3390/v16040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
The prevalence of hepatitis B and delta viruses (HBV/HDV) among people who use drugs (PWUD) remains largely unknown. In the context of one Philadelphia-based harm reduction organization (HRO), this study aimed to assess HBV/HDV prevalence and facilitate linkage to care. Participants completed a demographic HBV/HDV risk factor survey and were screened for HBV and reflexively for HDV if positive for HBV surface antigen or isolated core antibody. Fisher's exact tests and regression were used to understand relationships between risks and HBV blood markers. Of the 498 participants, 126 (25.3%) did not have hepatitis B immunity, 52.6% had been vaccinated against HBV, and 17.9% had recovered from a past infection. Eleven (2.2%) participants tested positive for isolated HBV core antibody, 10 (2.0%) for HBV surface antigen, and one (0.2%) for HDV antibody. History of incarceration was associated with current HBV infection, while transactional sex and experience of homelessness were predictive of previous exposure. This study found high rates of current and past HBV infection, and a 10% HBV/HDV co-infection rate. Despite availability of vaccine, one quarter of participants remained vulnerable to infection. Findings demonstrate the need to improve low-threshold HBV/HDV screening, vaccination, and linkage to care among PWUD. The study also identified gaps in the HBV/HDV care cascade, including lack of point-of-care diagnostics and lack of support for HROs to provide HBV services.
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Affiliation(s)
| | | | - Holly Moore
- Hepatitis B Foundation, Doylestown, PA 18902, USA
| | - Kara Sapp
- Hepatitis B Foundation, Doylestown, PA 18902, USA
| | | | - Rachel Holbert
- HepTREC at Prevention Point Philadelphia, Philadelphia, PA 19134, USA
| | | | - Daljinder Bhangoo
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, PA 18902, USA
| | - Richard W. Hass
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Amy Jessop
- HepTREC at Prevention Point Philadelphia, Philadelphia, PA 19134, USA
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Yang J, Lo NC, Dankwa EA, Donnelly CA, Gupta R, Montgomery MP, Weng MK, Martin NK. Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States. Clin Infect Dis 2024; 78:976-982. [PMID: 37738564 PMCID: PMC11006109 DOI: 10.1093/cid/ciad552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Widespread outbreaks of person-to-person transmitted hepatitis A virus (HAV), particularly among people who inject drugs (PWID), continue across the United States and globally. However, the herd immunity threshold and vaccination coverage required to prevent outbreaks are unknown. We used surveillance data and dynamic modeling to estimate herd immunity thresholds among PWID in 16 US states. METHODS We used a previously published dynamic model of HAV transmission calibrated to surveillance data from outbreaks involving PWID in 16 states. Using state-level calibrated models, we estimated the basic reproduction number (R0) and herd immunity threshold for PWID in each state. We performed a meta-analysis of herd immunity thresholds to determine the critical vaccination coverage required to prevent most HAV outbreaks among PWID. RESULTS Estimates of R0 for HAV infection ranged from 2.2 (95% confidence interval [CI], 1.9-2.5) for North Carolina to 5.0 (95% CI, 4.5-5.6) for West Virginia. Corresponding herd immunity thresholds ranged from 55% (95% CI, 47%-61%) for North Carolina to 80% (95% CI, 78%-82%) for West Virginia. Based on the meta-analysis, we estimated a pooled herd immunity threshold of 64% (95% CI, 61%-68%; 90% prediction interval, 52%-76%) among PWID. Using the prediction interval upper bound (76%) and assuming 95% vaccine efficacy, we estimated that vaccination coverage of 80% could prevent most HAV outbreaks. CONCLUSIONS Hepatitis A vaccination programs in the United States may need to achieve vaccination coverage of at least 80% among PWID in order to prevent most HAV outbreaks among this population.
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Affiliation(s)
- Judy Yang
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuelle A Dankwa
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Ribhav Gupta
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martha P Montgomery
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark K Weng
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Streifel AC, Rivera Sarti JE, Sikka MK, Conte M, Winders B, Varley CD. Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances. Ther Adv Infect Dis 2024; 11:20499361241245822. [PMID: 38681966 PMCID: PMC11055482 DOI: 10.1177/20499361241245822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. Design and methods We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. Results We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Conclusion Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.
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Affiliation(s)
- Amber C. Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Jose Eduardo Rivera Sarti
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Monica K. Sikka
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Michael Conte
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Bradie Winders
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Cara D. Varley
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mailcode L457, Portland, OR 97239-3098, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Supporting syringe services programs in the initiation and scale-up of vaccine administration: findings from in-depth interviews. Harm Reduct J 2022; 19:100. [PMID: 36050735 PMCID: PMC9435406 DOI: 10.1186/s12954-022-00681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs.
Methods We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. Results Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often took precedence. Staffing, physical space, and logistical issues were the most common barriers to vaccine administration reported by SSPs, followed by SSP participant-related barriers. Facilitators of vaccine administration included access to a tracking system, partnering with agencies or other organizations providing vaccines, and having a licensed vaccination provider on-site. Partnerships provided SSPs opportunities to expand capacity but could also restrict how SSPs operate. Recommended policy changes to facilitate vaccine administration included subsidizing the cost of vaccinations and addressing restrictions around who could administer vaccinations. Conclusions Increasing the availability of vaccination services at SSPs requires addressing the varying capacity needs of SSPs, such as tracking systems, licensed vaccinators, and free or low-cost vaccination supplies. While these needs can be met through partnerships and supportive policies, both must consider and reflect cultural competence around the lived experiences of persons who inject drugs.
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Montgomery MP, Zhong Y, Roberts E, Asher A, Bixler D, Doshani M, Christensen A, Eckert M, Weng MK, Carry M, Samuel CR, Teshale EH. Vaccination barriers and opportunities at syringe services programs in the United States, June-August 2021-A cross-sectional survey. Drug Alcohol Depend 2022; 237:109540. [PMID: 35753280 DOI: 10.1016/j.drugalcdep.2022.109540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) are an important venue for reaching people who inject drugs (PWID) to offer preventive services; however, not all SSPs offer vaccinations. We aimed to describe barriers and opportunities for SSPs to offer vaccinations. METHODS During June-August 2021, we conducted a descriptive, cross-sectional survey of SSP providers in the United States. SSPs were recruited from national listservs using purposive sampling to ensure geographic diversity. The survey included questions about SSP characteristics, client demographics, existing vaccination resources, resource needs, and staff perspectives on client vaccination barriers. Statistical comparisons were made using Pearson's chi-square test. RESULTS In total, 105 SSPs from 34 states responded to the survey; 46 SSPs (43.8%) offered on-site vaccinations. SSPs without on-site vaccinations were more likely operated by community-based organizations (81.4% vs 30.4%, p < 0.001) in urban areas (71.4% vs 40.0%, p = 0.002) than SSPs offering on-site vaccinations. The most common staffing need was for personnel licensed to administer vaccines (74/98, 75.5%). Over half of SSPs reported vaccine supply, administration supplies, storage equipment, and systems to follow-up clients for multidose series as important resource needs. The most common resource need was for reminder/recall systems for vaccines with multidose series (75/92, 81.5%). Vaccine safety concerns (92/95, 96.8%) and competing priorities (92/96, 95.8%) were the most common staff-reported client barriers to vaccinations. CONCLUSIONS Addressing missed opportunities for offering vaccinations to PWID who use SSPs will require increased numbers of on-site personnel licensed to administer vaccines and additional training, vaccination supplies, and storage and handling equipment.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Emma Roberts
- National Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY 10001, USA
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Danae Bixler
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Aleta Christensen
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Maribeth Eckert
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mark K Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Monique Carry
- Division of Global HIV & TB, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Christina R Samuel
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
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Partida D, Powell J, Gonzalez D, Khalili M. Gaps in hepatitis A and hepatitis B vaccination among hepatitis C antibody positive individuals experiencing homelessness. Open Forum Infect Dis 2022; 9:ofac175. [PMID: 35531381 PMCID: PMC9070334 DOI: 10.1093/ofid/ofac175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Vaccination for both hepatitis A (HAV) and hepatitis B (HBV) is recommended in hepatitis C infection (HCV). Among HCV antibody–positive persons experiencing homelessness, we identified high rates of HAV (34%) and HBV vaccine (35%) eligibility, highlighting critical gaps in HCV preventative services. Following education, 54% and 72% underwent HAV and HBV vaccination, respectively.
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Affiliation(s)
- Diana Partida
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Daniel Gonzalez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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