Hepatitis B Immunization Practices at an Urban STD Clinic

Background:
The Southeast STD Clinic, the only publicly funded STD clinic in Washington, DC, implemented routine hepatitis B vaccination for all clients in November 2001.

Objective:
To evaluate: the percentage of clients accepting the hepatitis B vaccine, the percentage of accepting clients completing the hepatitis B vaccine series, and factors associated with hepatitis B vaccine acceptance and completion.

Method:
We studied a randomly selected sample of the 8,536 new adult clients who visited the clinic between October 2003 and October 2006. Data from paper based medical records, the master hepatitis B vaccination log, and STD*MIS were collected and analyzed.

Result:
698 clients were included and were representative of the clinic's general patient population - mean age was 29.8 years; 64% were male; 83% were African American, 11% were Caucasian and 4% were Hispanic. Thirty (4%) clients accepted the first hepatitis B dose. Acceptance was higher among clients referred by other clinics; who admitted to cocaine and/or heroin use; and with a history of IDU and/or liver disease. Nine (30%) clients completed the hepatitis B vaccination series. Completion was higher among clients who admitted to heroine use and those with a history of IDU, nongonococcal urethritis infection, and liver disease.

Conclusion:
Assuming all new clients included were eligible, hepatitis B vaccine acceptance and completion were low at the Southeast STD Clinic. Reasons for non-acceptance of the hepatitis B vaccine should be documented. Acceptance and completion were associated with the risk factors for hepatitis A vaccination (IDU and liver disease) which the clinic began offering in May 2004. Trends over time need to be analyzed.

Implications:
Concerted and continued efforts are required to provide universal hepatitis B vaccination in care settings where a high proportion of clients are at risk for hepatitis B virus (HBV) infection.