Hepatitis B vaccination urged in adults

Ioannou GN. Ann Intern Med. 2011;154:319-328.

Hepatitis B vaccination has resulted in a population of children and adolescents with “very high rates of immunity and very low rates of infection;” however, disease rates remain higher in adults, thereby demonstrating the importance of hepatitis B vaccination in this population, according to a study published online this week.

George N. Ioannou, BMBCh, MS, of the Veterans Affairs Puget Sound Health Care System, in Seattle, and colleagues looked at survey results from about 40,000 participants enrolled in the National Health and Nutrition Examination Survey.

Ioannou defined chronic HBV infection as having a serum HBV surface antigen and past exposure to hepatitis B core antigen among participants who were older than 6 years.

“Among persons aged 6 years or older, 0.27% (95% CI, 0.20-0.34) had chronic HBV infection,” Ioannou said, adding that this ratio corresponds to about 704,000 people nationwide. About 4.6% of these survey participants had been exposed to HBV.

He said this ratio is significantly lower than estimates of infection and exposure in the United States that were reported before 1994, which is when federal programs began to back universal vaccination for children.

Ioannou said HBV prevalence increased with age.

“Children aged 2 years have high rates of immunity (68.6%; CI, 64.1-73.2),” he said, adding that adults, however, had much lower rates of immunity.

The study may have overestimated the vaccine’s effectiveness because most of the children that were vaccinated under the universal recommendations in 1992 would likely not have reached adulthood by the survey period’s conclusion in 2008, Ioannou said.

Disclosure: The Veterans Affairs Research Award Program provided most of the funding for the study.

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