title: Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007.
abstract: OBJECTIVE
  In the USA, the burden of hepatitis B disproportionately affects high-risk adults who alone account for more than 75% of newly reported hepatitis B virus infections each year. Despite the localization of new infections in identifiable high-risk groups, vaccination rates in this subgroup, with the exception of health care workers, remain consistently low. The purpose of this study was to characterize those at risk for hepatitis B transmission and quantify the association between missed opportunities and hepatitis B vaccination.
  
  
  METHODS
  Data from the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS) of adults aged 18 years and older who were at high risk for hepatitis B infection (n = 15,432) were analyzed. Multivariate regression analysis was conducted to determine factors independently associated with vaccination.
  
  
  RESULTS
  In a nationally representative sample, 51.4% of high-risk adults remained unvaccinated against hepatitis B and more than 50% had a missed opportunity for vaccination. High-risk adults who were vaccinated against pneumonia and influenza had a higher odds ratio of being vaccinated against hepatitis B than those not vaccinated against pneumonia and influenza (OR 2.27 and 1.67, respectively). Also, high-risk adults tested for human immunodeficiency virus (HIV) at a counseling and testing site or a drug treatment facility had a higher OR of being vaccinated than those who had not been tested for HIV (OR 1.78 and 1.73, respectively). The opposite relationship was true among individuals tested for HIV at a correctional facility (OR 0.60).
  
  
  CONCLUSIONS
  The findings of this study underscore the inadequacy of vaccination coverage in high-risk adults and highlight advantageous opportunities to bridge gaps in vaccination coverage.
authors.affiliation: Program in Public Health, Division of Biomedicine, Brown University, 121 South Main Street, Box G, Providence, RI 02903, USA. farah.ladak@gmail.com
authors.forename: F
authors.initials: F
authors.lastname: Ladak
authors.forename: A
authors.initials: A
authors.lastname: Gjelsvik
authors.forename: E
authors.initials: E
authors.lastname: Feller
authors.forename: S R
authors.initials: SR
authors.lastname: Rosenthal
authors.forename: S
authors.initials: S
authors.lastname: Rosenthal
authors.forename: B T
authors.initials: BT
authors.lastname: Montague
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D017325:Hepatitis B Vaccines