Barriers to hepatitis B immunization in adolescents – adapted from the Journal of Adolescent Health 1995;17:244-7 – Tips from Other Journals
Hepatitis B (HBV) is a leading cause of morbidity, mortality and economic loss in the United States. It is estimated that approximately 300,000 HBV infections occur annually, resulting 20,000 chronic infections and over 4,000 deaths. The majority of these infections occur in adolescents and young adults. Although an effective vaccine has been available for more than a decade, the incidence of HBV infection has continued to increase. Adolescents and young adults are at significant risk of HBV infection for several reasons. Since the disease is initially unrecognized in approximately half of cases, potentially infectious individuals are undetected in the community. Risk-taking behaviors, particularly those related to practices and drug use, are common in this age group and raise the risk of acquiring HBV infection.
A comprehensive review by Lawrence and Goldstein reports several strategies and recommendations of expert groups. The hepatitis B vaccine has few medical adverse effects, but significant problems of cost and logistics are associated with implementation of a universal vaccination policy. Three injections are generally recommended for protective immunity, but 81 percent of healthy adolescents develop adequate antibody levels after two injections. The current cost of up to $200 for the three-injection series is a substantial barrier to universal vaccination. This barrier is only likely to be overcome by government action. The authors recommend a universal immunization policy directed at middle school students.
In a related article, Cassidy and Mahoney report that 79 percent of 654 students in a Louisiana middle school received at least one hepatitis B vaccination during a special program. Three vaccinations were completed by 65 percent of students. The greatest barrier to vaccination was inability to obtain parental consent. Postvaccination testing was performed in 103 students, of whom 96 percent had developed protective antibody levels. The individual cost of vaccination for those receiving three doses was $77.23. The authors conclude that middle school vaccination nation programs can be successfully implemented using school-based clinics. (Lawrence ME, et al. Hepatitis B immunization in adolescents. J Health 1995;17:234-43, and Cassidy WM, et al. A hepatitis B vaccination program targeting adolescents. J Adolesc Health 1995;17:244-7.)
COPYRIGHT 1996 American Academy of Family Physicians
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