improve hepatitis B vaccine coverage (Mast et al., 2006). A key to the success of such an approach is the routine availability of hepatitis B vaccine in settings where a high proportion of persons who have risk factors are seen (such as STD clinics), in primary-care and specialty-care medical settings, and in occupational-health programs.

Identification of at-risk people is particularly challenging in medical settings in that risks must be assessed in individual patients. In many health-care settings, physicians and other providers might not be comfortable in asking direct questions to elicit risk history with respect to sexual or percutaneous exposures (Ashton et al., 2002; Bull et al., 1999; Maheux et al., 1995). Time constraints during medical appointments and inadequate provider education in the assessment of risk histories also might lead to insufficient assessment of risk history. In addition, there may be discrepancies between a patient’s self-assessment of risk and a health-care provider’s documented assessment (Fishbein et al., 2006). Therefore, the ACIP recommends that hepatitis B vaccination be offered to any adult who requests it, regardless of a provider’s assessment of risk (Mast et al., 2006).

Recommendation

In 2007, there were more than 40,000 new acute HBV infections in adults (Daniels et al., 2009). To reduce the incidence of HBV infection in adults, the committee offers the following recommendation:

Recommendation 4-3. Additional federal and state resources should be devoted to increasing hepatitis B vaccination of at-risk adults.

  • Correctional institutions should offer hepatitis B vaccination to all incarcerated persons. Accelerated schedules for vaccine administration should be considered for jail inmates.

  • Organizations that serve high-risk people should offer the hepatitis B vaccination series.

  • Efforts should be made to improve identification of at-risk adults. Health-care providers should routinely seek risk histories from adult patients through direct questioning and self-assessment.

  • Efforts should be made to increase rates of completion of the vaccine series in adults.

  • Federal and state agencies should determine gaps in hepatitis B vaccine coverage among at-risk adults annually and estimate the resources needed to fill the gaps.



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