Hepatitis B Vaccination Among High-Risk Adults: Results from the National Health and Nutrition Examination Survey (NHANES), 2003-2010

Background: Hepatitis B virus (HBV) infection can be prevented through vaccination, but only an estimated 24%-50% of high-risk adults in the United States have been vaccinated against HBV infection. 

Methods: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) for two time periods, 2003-2006 (n=6459 adults) and 2007-2010 (n=6652 adults) to: (1) assess the self-reported prevalence of hepatitis B vaccination uptake and the intrapersonal, interpersonal, and organizational level factors associated with receiving hepatitis B vaccination among US adults; and (2) assess whether any changes occurred in the prevalence of and factors associated with hepatitis B vaccination uptake among high-risk adults from 2003-2006 to 2007-2010.  A high-risk adult was defined as any adult reporting at least one of the following: a sexually transmitted infection in the past 12 months (e.g., herpes, chlamydia, gonorrhea, or genital warts), sex with another man if male, infection with HIV, or past or current injection drug use.  All other adults were classified as non-high-risk.

Results: In 2003-2006, five variables were independently associated with hepatitis B vaccination uptake: younger age; female sex; non-Hispanic Black or “other” race/ethnicity; having greater than a high school education; and having health insurance.  In 2007-2010, six variables were independently associated with hepatitis B vaccination uptake which included again: younger age; female sex, non-Hispanic Black race/ethnicity; having greater than a high school education; having health insurance; but now also being a high-risk adult.  Among high risk adults (n=427), the prevalence of hepatitis B vaccination uptake increased from 37.6% in 2003-2006 to 47.0% in 2007-2010.  

Conclusions:Still less than one-half of high-risk adults in the U.S have been vaccinated against HBV infection.  Urgent strategies that that facilitate vaccination are needed to improve uptake among high-risk adults to reach the national goal of eliminating HBV infection in the United States.